Public Health – Tarrant County Physician Online

Your Attention, Please! A Commentary on the Delayed Diagnosis of ADHD in Female Patients

TCOM Student Article

By Cassandra Miller, OMS-II

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

Are you prone to losing things? Are you frequently absentminded or easily distracted? These tendencies may seem like the byproducts of a busy lifestyle or personality traits. However, they may also reflect an underlying condition such as an undiagnosed neurodevelopmental disorder like Attention-Deficit/Hyperactivity Disorder (ADHD). Historically, ADHD has been regarded as a predominantly male disorder, leading to gender-based bias in diagnostic criteria and clinical recognition.^1,2 As a result, many female patients remain undiagnosed during childhood. Recent literature suggests that the increasing rate of ADHD diagnoses in women later in life may be linked to differences in symptom presentation, the development of compensatory masking behaviors that obscure clinical detection, and symptom overlap between various psychiatric conditions.^3,4 Addressing diagnostic gaps is of paramount importance to improving early identification of ADHD in female patients and optimizing long-term treatment outcomes.

Despite increasing awareness of ADHD’s prevalence, it remains underrecognized in younger females. Original ADHD diagnostic criteria were derived from studies of hyperactive boys and placed emphasis on behaviors such as impulsivity.¹ As a result, patients with primarily inattentive symptoms are less likely to be diagnosed in childhood. This disparity in diagnosis contributes to the pattern of women being diagnosed in adulthood, as they tend to exhibit primarily inattentive symptoms such as difficulties with time management, overall task completion, and frequent mistakes during routine activities.³

Another contributor to the delayed diagnosis of ADHD in women is the phenomenon of masking. Masking is defined as “a key component of social camouflaging and refers to the concealment of neurodivergent traits and the adoption of alternate social personas.”^5,6 Although more heavily studied in the context of Autism Spectrum Disorder, masking can have positive social effects in overcoming societal stigma associated with ADHD.6 However, this method of meeting external expectations can prove challenging for clinicians as key symptoms may be obscured. Additionally, masking can be exhausting for patients and, over time, lead to poor self-esteem and burnout.^5,6 This, coupled with a disproportionate rate of psychiatric comorbidity in women, represents another factor in ADHD misdiagnosis.

Moreover, women with ADHD are more likely to be diagnosed with a mood or anxiety disorder prior to receiving an ADHD diagnosis.⁷ The overlap in symptoms across these psychiatric conditions can lead clinicians to attribute symptoms such as impaired concentration, restlessness, and emotional dysregulation to mood disorders rather than a neurodevelopmental disorder.7 As a result of delayed diagnosis, ineffective and potentially unnecessary treatments may ensue.

Delayed diagnosis has also been attributed to sociocultural and hormonal factors.³ Regardless, the consequences of delayed diagnosis are substantial. Women with a late ADHD diagnosis report higher levels of academic underachievement, interpersonal difficulties, and feelings of shame.⁶ Clinical education to reduce diagnostic bias and refinement of screening tools is vital to bridging this gender-based gap and reducing the long-term burden of untreated ADHD in young women.

References:

Stephen P. Hinshaw, Phuc T. Nguyen, Sinclaire M. O’Grady, and Emily A. Rosenthal, “Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions,” Journal of Child Psychology and Psychiatry 63, no. 4 (2022): 484–496, https://doi.org/10.1111/jcpp.13480.
Patricia O. Quinn and Manisha Madhoo, “ADHD in Women and Girls: Uncovering This Hidden Diagnosis,” Primary Care Companion for CNS Disorders 16, no. 3 (2014), https://pubmed.ncbi.nlm.nih.gov/25317366/.
Susan Young et al., “Females with ADHD: An Expert Consensus Statement Taking a Lifespan Approach Providing Guidance for the Identification and Treatment of Attention-Deficit/Hyperactivity Disorder in Girls and Women,” BMC Psychiatry 20, no. 1 (2020): 404, https://pubmed.ncbi.nlm.nih.gov/32787804/.
Joanna C. Agnew-Blais, “Hidden in Plain Sight: Delayed ADHD Diagnosis in Girls and Women,” Journal of Child Psychology and Psychiatry 65, no. 9 (2024): 1018–1020, https://pubmed.ncbi.nlm.nih.gov/38798101/.
Patricia Wurth et al., “Masking in Adults with Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder: A Systematic Review,” Frontiers in Psychiatry 16 (2025), https://doi.org/10.3389/fpsyt.2025.1668780.
Emily Holden and Helen Kobayashi-Wood, “The Adverse Life Experiences of Women with Undiagnosed Attention-Deficit/Hyperactivity Disorder: A Qualitative Study,” Scientific Reports 15 (2025), https://doi.org/10.1038/s41598-025-04782-y.
Darby E. Attoe and Emma A. Climie, “Miss. Diagnosis: A Systematic Review of ADHD in Adult Women,” Journal of Attention Disorders 27, no. 7 (2023): 645–657, https://doi.org/10.1177/10870547231161533.

AI Analyzes Data, but Whole-Person Care Still Matters

Feature Article

By Nelumdini Samaranayake, PhD, Assistant Professor
Department of Medical Education and Health Systems Science at Texas College of Osteopathic Medicine, UNT Health Fort Worth

Sponsored by Robert Bunata, MD

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

Artificial Intelligence (AI) is no longer something discussed only as the future of medicine; it is already part of everyday healthcare practice. From documentation and ambient scribing to decision-support tools, AI is increasingly integrated into the workflows physicians use each day. In many ways, these technologies are improving efficiency, reducing administrative burden, and helping clinicians manage growing amounts of clinical information. This article reflects the rapidly changing developments and evidence available as of May 2026.

As this technology continues to evolve in healthcare, an important question emerges: how will AI—and how should AI—influence the way clinicians think and make decisions? AI excels at identifying problems, processing vast amounts of data, detecting differences that might otherwise go unnoticed, and offering insights faster than any human could.

Cardiologist and author Eric Topol notes in Deep Medicine that, as technology becomes more capable of handling technical tasks, it may create more space for human-centered care in healthcare.¹ While AI has the potential to support broader clinical insight and decision-making, human interpretation and communication, along with the ability to understand a patient’s real-life circumstances, cannot be fully replaced by technology.

What AI Does Not Fully Capture
What AI often struggles to capture is the bigger picture surrounding the patient.
Although newer AI systems are increasingly capable of analyzing conversational, behavioral, and contextual information, the challenge has shifted from simply processing data to meaningfully understanding the broader context of an individual’s life and circumstances. AI may detect patterns in speech, documentation, and other data sources, but it does not experience a patient’s circumstances firsthand. Family concerns, cultural influences, financial realities, and unspoken worries often require human interpretation and meaningful conversation to fully understand. These factors can be difficult to measure, and even when represented in data, they may not always be recognized within the context of an individual patient’s life.

As AI becomes more integrated into care, there is a growing risk of overly narrow clinical thinking, where complex human conditions are interpreted primarily through structured data. A patient can gradually become a set of variables rather than a person with a story. While this may improve efficiency, it can narrow clinical reasoning in ways that are not immediately obvious.

When Data Does Not Tell the Whole Story
This becomes particularly relevant in educational discussions when considering a patient with poorly controlled diabetes. An AI tool may appropriately highlight lab values and suggest adjustments to the treatment plan. From a data standpoint, that recommendation makes sense. However, even when social, cultural, and environmental factors are available, understanding how they influence a patient’s daily life can be more complex. Access to food, cultural dietary practices, health literacy, transportation barriers, financial constraints, and social support may affect whether a recommendation is realistic, acceptable, or sustainable for an individual patient. While AI may increasingly incorporate such information into its analyses, determining how these factors shape a patient’s choices and circumstances often requires human judgment, conversation, and shared decision-making. Without that broader understanding, even the most evidence-informed recommendation may not work effectively in practice. This is where thoughtful integration becomes important. AI should be viewed as a tool. Although powerful, it remains a tool. It is not the decision-maker, and it does not carry responsibility or accountability. Those responsibilities remain with clinicians. The concern is not the presence of AI itself, but how increasing reliance on these tools may skew clinical reasoning over time.

Trust in AI is not only a technical challenge but also a legal one. Recent healthcare AI discussions published in JAMA have highlighted that regulatory and accountability frameworks are still evolving, leaving important questions unanswered regarding accountability, oversight, and liability when AI-supported tools contribute to errors or patient harm. As AI becomes increasingly integrated into healthcare decision-making, establishing clear standards for accountability will be essential for maintaining public trust.²

The Responsibility Still Belongs to Us
We are already seeing AI embedded in documentation workflows, particularly through the use of ambient scribing technologies. These tools can generate clinical notes, summarize encounters, and even suggest language for patient communication. They may reduce administrative burden and allow physicians to spend more time interacting directly with patients, which is a meaningful advancement. However, their use also requires careful clinical judgment and oversight. There have been situations in which AI-generated outputs were shared with patients without being fully reviewed or validated. In some cases, information that appeared to represent a diagnosis or clinical conclusion created confusion or unnecessary distress when it had not been carefully verified by the responsible physician. These moments are not failures of technology alone; they are reminders of how easily shortcuts can influence communication and clinical interpretation. They reinforce an important point: anything generated by AI must be reviewed, interpreted, and confirmed before it is shared with a patient. This includes not only the accuracy of the information itself, but whether it is appropriate for the situation and whether the patient has been adequately prepared.

Clear communication and informed patient consent are not optional steps; they are essential components of care. AI does not remove that responsibility; it reinforces it.

Why Clinical Judgment Matters More
As healthcare environments become increasingly influenced by AI, the role of the clinician becomes more important. AI should not come first in the clinical process. Instead, it should come after an initial, patient-centered assessment. First, we engage with the patient; we listen, observe, and begin to understand their story. Then we form an initial impression grounded in both data and human interaction. Afterward, AI may be used to expand or challenge that thinking. This sequence matters because it preserves clinical reasoning while allowing AI to serve as a cognitive support tool rather than a directive force. This approach helps keep clinical decision-making focused on the patient rather than solely on algorithmic output. Equally important is maintaining a mindset of critical evaluation.

AI systems are not perfect. They can generate highly confident responses that are incorrect, particularly when built on biased, incomplete, and non-representative data. They may produce outputs that appear highly credible but lack important context or accuracy. In those moments, the clinician must be willing to pause, question, and reassess. This is not about distrust, but responsibility. The presence of AI requires us to think more carefully, not less. It challenges us to ask better questions: Does this output align with what I am seeing? What might be missing? What does the patient’s situation reveal that the data does not? These are the questions that protect against over-reliance and preserve sound clinical judgment.

Looking Ahead
The role of AI in medicine goes beyond technology. It influences how clinicians think, how decisions are made, how information is presented, and how care is delivered. As AI continues to grow within healthcare, it brings both valuable opportunities and new responsibilities.

The benefits are promising. AI can assist clinicians in processing information, recognizing patterns within datasets, and highlighting details that may otherwise go unnoticed. When used thoughtfully, these tools can strengthen clinical assessment and support decision-making without replacing professional judgment. But the risk is less visible. If we are not careful, AI can narrow our thinking. Clinical attention can gradually shift toward structured data while real-life circumstances receive less consideration. Over time, this can influence how patients are understood and how decisions are made.
This issue is not rooted solely in AI. In many ways, the outcome depends on how thoughtfully these tools are incorporated into clinical care. It also creates an opportunity to shape how future clinicians think about AI—not as a shortcut or an answer engine, but as a tool that requires interpretation, reflection, and responsibility. We can guide this use of AI to strengthen clinical reasoning rather than weaken it. AI may assist with information analysis, but medicine continues to rely on human interpretation, empathy, and trust. Medicine is not defined by competing with machines in processing data. That is not where our value lies. It is in the human qualities that machines cannot replace. We understand nuance. We interpret context. We recognize emotion. We build trust. We see the patient not as a set of data points, but as a person with a life, a story, and circumstances that matter.

AI may assist in clinical decision-making, but accountability, interpretation, and patient care remain human responsibilities. While AI can analyze data, clinicians are still responsible for seeing the whole person. AI is already a part of everyday medicine; now the question is how AI will shape the way we think, decide, and care.

References

Eric Topol, Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again (New York: Basic Books, 2019).
Michelle M. Mello and I. Glenn Cohen, “Regulation of Health and Health Care Artificial Intelligence,” JAMA 333, no. 20 (2025): 1769–1770, https://jamanetwork.com/journals/jama/fullarticle/2831831.

Women’s Mental Health: The Barriers to Access

The President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the July/August 2026 issue of Tarrant County Physician.

This May, I had the privilege of presenting at a workshop with psychiatric colleagues regarding women’s mental health at the annual meeting of the American Psychiatric Association. We had strong attendance and a robust discussion. But given all the questions from our audience members, it became evident to me that this is a topic deserving of additional outreach, and not just to fellow psychiatrists. However, I had a dilemma . . . a draft deadline and multiple PowerPoint slides with all the information. After a couple of hours of trying to gather everything into a cohesive article to present to you all here, I decided to seek the assistance of AI. I dumped everything I had into Copilot, gave it about four dozen or more prompts, and it coalesced all my work. I still had to edit extensively; who knew that Copilot was so fond of run-on sentences?! The following has been further edited by the people who help maintain the decorum of our Tarrant County Physician journal.

Women’s mental health is as much an access issue as a diagnostic one. Across clinical settings, it is common to see:

Depression

Anxiety

Trauma-related conditions

Perinatal Mental Health Challenges

Emotional strain associated with:
• Caregiving responsibilities
• Financial hardship
• Discrimination
• Chronic disease

Whether these concerns are recognized, disclosed, and treated is often shaped by social context, such as current physical environment and cultural and/or historical aspects of different communities. Insurance, transportation, childcare, translation services, stigma, community trust, and local behavioral health capacity all affect timely care. Women in underserved communities are at particular risk for late diagnosis and interrupted treatment because social determinants of health and health system barriers often converge. And national mental health workforce shortage areas remain widespread.¹

Underserved care is not found in a single setting but is a condition of limited access that can exist anywhere. A woman may live in a rural county with the closest psychiatrist being a long drive away. Another woman may live in an urban neighborhood with multiple hospitals yet still face long waits, unaffordable copays, language barriers, and fragmented referral pathways. In both settings, available services may not be truly usable. Women may present late, rely on urgent care, or disengage when treatment plans fail to account for barriers such as housing instability, caregiving demands, or work schedules. For physicians, treatment planning must address not only diagnosis and severity but also whether follow-up is realistic.

Rural and urban settings pose different challenges. In rural practice, barriers often include distance, limited specialist supply, service closures, privacy concerns, and broadband gaps that weaken telehealth. In urban settings, the problem is often system complexity: long wait times, fragmented care, uneven service distribution, insurance limitations, and cultural or linguistic mismatch between a patient and their physician. These differences require different responses. Rural physicians may depend more on collaborative care, telepsychiatry, and cross-system referral relationships, whereas urban physicians may focus on reducing handoff failures, improving navigation, and integrating behavioral health into primary care or women’s health clinics. Rural counties fare worse than non-rural counties on measures of clinical care and social determinants of health,² and shortage designations affect both rural and urban areas.¹

Perinatal mental health is critically important, but risks change across the lifespan. Anxiety, depression, trauma exposure, eating disorders, self-harm risk, intimate partner violence, caregiving stress, chronic illness, loneliness, grief, and cognitive concerns may present differently at each stage of life. In underserved communities, unstable housing, food insecurity, discrimination, limited preventive care, and delayed treatment can intensify symptoms and complicate care. A useful clinical framework goes beyond symptom checklists to assess safety, functioning, social stressors, and barriers to follow-up.
Routine screening is one of the strongest opportunities to improve women’s mental health care, but only when paired with a workflow that supports action. In women’s health, primary care, and perinatal settings, screening can identify depression, anxiety, trauma-related symptoms, and safety concerns before they escalate. A positive screen should trigger a risk assessment, a discussion of treatment options, a referral or warm handoff when indicated, and a plan for monitoring response and adherence. Routine screening for depression and anxiety is recommended in well-woman, pre-pregnancy, prenatal, and postpartum care. Standardized instruments and systems for timely assessment, treatment, and follow-up are also recommended.³

Care models should reflect practice realities rather than assume one solution fits all. In rural settings, telehealth can reduce travel burdens and extend specialty access, especially when supported by audio-only options and coordination with local primary care. In urban settings, access may improve more through shorter referral loops, stronger safety-net capacity, co-located behavioral health services, and language-concordant care. Telehealth is most effective when patients have the privacy, reliable connectivity, digital skills, and device access needed to use it. Underserved communities may also benefit from multiple telehealth formats, including phone-based care.⁴ At the same time, rural telehealth continues to face setting-specific implementation barriers.⁵

As you can see, addressing women’s mental health requires a layered, setting-specific approach. Trauma-informed, culturally responsive care is essential. In rural settings, physicians may need to offset workforce shortages and distance through collaborative care and telehealth-enabled consultation. In urban settings, the priority is often reducing fragmentation and improving access within systems that may appear resource-rich but remain difficult to navigate.
Ultimately, the central question is not simply whether a patient lives in a rural or urban area, but whether she can obtain timely, acceptable, and practical care. That requires early identification, realistic care planning, and systems that coordinate between screening, referral, and treatment. For physicians, the implication is straightforward: overcoming social barriers is part of the care plan, not peripheral to it.

“Healing takes time, and asking for help is a courageous step.” —Mariska Hargitay

References:

Health Resources and Services Administration, “Health Workforce Shortage Areas,” accessed June 30, 2026, https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard.
W. B. Weeks et al., “Rural-Urban Disparities in Health Outcomes, Clinical Care, Health Behaviors, and Social Determinants of Health and an Action-Oriented, Dynamic Tool for Visualizing Them,” PLOS Global Public Health 3, no. 10 (2023): e0002420, https://doi.org/10.1371/journal.pgph.0002420.
American College of Obstetricians and Gynecologists, “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum,” Clinical Practice Guideline, June 2023, https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum.
U.S. Department of Health and Human Services, “Telehealth for Underserved Communities,” August 20, 2024, https://telehealth.hhs.gov/documents/Telehealth_for_Underserved_Communities_08-20-24.pdf.
Rural Health Information Hub, “Rural Telehealth Toolkit,” last modified June 8, 2023, https://www.ruralhealthinfo.org/toolkits/telehealth.
Centers for Disease Control and Prevention, “Social Determinants of Health,” last modified May 16, 2024, https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html.

Beyond the Desk: Where This Work Really Happens

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

Over the past month, much of our Project Access work did not take place at a desk.

It began at a conference hosted by Texas A&M Fort Worth where we presented alongside other professionals on the role of Medical-Legal Partnerships in addressing barriers to care. The conversation focused on collaboration and how healthcare, legal, and community-based organizations can work together more effectively to support patients navigating complex systems. PATC had the honor of presenting what we are doing to combat barriers in our session, “When Noncompliance Isn’t the Problem: Addressing SDOH in Indigent Populations.”

Presenting at the Medical-Legal Partnerships Conference

Later in the month, the setting looked very different.

At a church gym in Arlington, a group of participants gathered for “Financial Confidence Starts Here,” a new endeavor within our Salud en tus Manos initiative. Led by a certified financial coach, the session focused on practical, real-life strategies: managing expenses, prioritizing financial obligations, and navigating the challenges that arise when a health issue disrupts income or stability.

These two settings—a professional conference and a community-based classroom—may appear unrelated. In practice, they are closely connected.
It is easy to assume that nonprofit healthcare coordination happens primarily behind the scenes through referrals, scheduling, and documentation. Those components are essential, but they represent only part of the work required to ensure that patients not only access care but are prepared to successfully complete it.

Teaching the “Financial Confidence Starts Here” class

Increasingly, we are seeing that what happens outside of traditional clinical settings has a measurable impact on what happens within them.

At the conference, conversations were centered on systems and how partnerships can reduce barriers and improve access at a structural level. In the classroom, those same barriers were discussed from a different perspective: how they are experienced in daily life. Participants asked practical questions about managing bills, handling unexpected expenses, and making decisions when financial and health challenges intersect.

Together, these experiences reinforce a consistent reality: access alone is not enough.

Patients benefit from care when they are prepared to engage with it—when they understand how to communicate with their providers, how to manage the logistical and financial aspects of treatment, and how to navigate the systems surrounding their care. Building that level of readiness often happens outside the exam room.

For our volunteer physicians, this work matters.

Patients who arrive with greater confidence, clearer understanding, and fewer external barriers are better positioned for efficient, effective visits. Time can be spent on clinical decision-making rather than navigating preventable obstacles. The work happening in community and professional settings ultimately supports the care delivered in clinical ones.

With PATC patients at Salud en tus Manos

For our funders, this work is equally important.

Initiatives like Salud en tus Manos continue to evolve in response to what we are seeing in the community. Expanding into teaching financial literacy through “Financial Confidence Starts Here” reflects a growing recognition that financial stability is closely tied to health outcomes. When patients are equipped with practical tools and knowledge, the impact of donated care is strengthened—appointments are kept, treatment plans are completed, and outcomes are more sustainable.

At Project Access Tarrant County, we remain committed to both.
The coordination of specialty and surgical care is and will always be central to our mission. At the same time, our work increasingly includes engagement in spaces that extend beyond traditional healthcare settings, whether through professional collaboration or direct community education.
Much of our work does happen behind the scenes.

But some of the most important work happens far beyond in conference rooms where ideas are shared, in classrooms where confidence is built, and in conversations that ensure when a patient finally sits in front of a physician, they are ready to fully engage in their care.

And that is where this work truly happens.

Advancing the Future of HIV Care in Our Community

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

The Preventive Medicine Clinic (PMC), the oldest Ryan White HIV clinic in Tarrant County, has served the community continuously since its founding in 1991. In 2026, Tarrant County Public Health marks a significant milestone—35 years of delivering comprehensive HIV care, prevention, and patient support through this foundational program. In recognition of this milestone, PMC is undergoing a strategic transformation aimed at expanding access, enhancing quality, and delivering care in a more cost-effective and sustainable manner.

This evolution calls for a new identity—one that reflects not only where we have been, but where we are going. Today, we introduce Thrive Health. People living with HIV are no longer simply surviving; with the right care and treatment, they are thriving, and our new identity is meant to reflect this new era of care.

But we are not simply a rebrand; we are also entering a new phase focused on integration, innovation, and system-wide collaboration to address a persistent challenge: HIV incidence remains steady, and in some populations, is increasing. This moment calls not only for recognition of past success but for decisive action moving forward.

The Ryan White System of Care in Tarrant County
The modern HIV care system in the United States is built in large part on the foundation of the Ryan White HIV/AIDS Program, administered by Health Resources and Services Administration, an agency of the US Department of Health and Human Services. First established in 1990, the program was named after Ryan White, a young hemophilia patient who became a national advocate for HIV awareness after facing significant stigma and discrimination.

This program was designed to address a critical gap by ensuring access to HIV care for individuals who were uninsured or underinsured during a time when treatment options were limited and outcomes were poor. Over time, it evolved into a comprehensive system of care that supports medical treatment, medications, and essential support services.

Today, the Ryan White HIV/AIDS Program represents a multi-billion-dollar federal investment, with annual national funding of approximately $2.6 billion, supporting care for more than half of all people living with HIV in the United States. It has been widely recognized for achieving some of the highest viral suppression rates of any federally funded healthcare program.

In Tarrant County, Ryan White funding supports a coordinated network of clinics, including Thrive Health and other regional partners, delivering comprehensive care that includes HIV primary medical services; antiretroviral therapy management; rapid-start treatment for newly diagnosed patients; PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) services; case management; mental health and substance use care; oral health; pharmacy support; laboratory monitoring; and assistance addressing housing and transportation. Through this integrated model, HIV has been transformed into a manageable chronic condition, with significant improvements in life expectancy and reductions in transmission.

Local Epidemiology: A Growing HIV Burden in Tarrant County
Unfortunately, in Tarrant County, as in other parts of the United States, the burden of HIV continues to grow. In 2022, it was estimated that approximately 6,715 individuals were living with HIV in Tarrant County. By 2026, that number has risen to an estimated range of 7,500 to 8,000 individuals.
This increase is multifactorial and reflects a number of factors:

Ongoing HIV transmission

Improved survival due to effective antiretroviral therapy
Population growth within Tarrant County
The downstream effects of the COVID-19 pandemic, which disrupted routine healthcare delivery, reduced access to HIV testing and prevention services, and contributed to delays in diagnosis and linkage to care

Collectively, these factors highlight the persistent gaps in prevention and access that must continue to be addressed by healthcare and public health experts.

Why Continued HIV Screening Matters
Despite advances in treatment, HIV remains a significant public health concern. Routine screening is critical because early diagnosis allows for immediate initiation of therapy, leading to improved individual outcomes and reduced transmission through viral suppression. At the same time, a substantial number of individuals remain undiagnosed or are diagnosed late in the course of disease.

Tarrant County Public Health’s Disease Surveillance, Outreach, and Prevention (DSOP) team plays a central role in HIV and STD control efforts. Their work includes conducting field-based testing and outreach in high-risk populations, performing partner services and contact tracing, and leading comprehensive contact investigations for newly diagnosed HIV and syphilis cases. In addition, DSOP facilitates linkage to care for newly diagnosed individuals and actively works to re-engage patients who have fallen out of care, while collaborating closely with clinicians and epidemiologists to monitor trends and improve outcomes.

In addition, for several years, a key success in Tarrant County has been the implementation of opt-out HIV screening at JPS Emergency Department. This innovative program has led to the identification of numerous new HIV cases and has improved linkage to care at Ryan White outpatient clinics.
Building on this success, Tarrant County Public Health, in collaboration with the Tarrant County HIV Administrative Agency and key physician leadership from JPS, is actively working with other local hospitals to expand opt-out HIV screening across emergency departments throughout the region, with the goal of standardizing testing practices and improving early detection across multiple healthcare systems. These initiatives, if successful, could improve early detection of HIV and treatment of people living with HIV, thus helping to stop the spread of this disease.

Thrive Health: A Transformational Model for Integrated, Cost-Effective, High-Value Care
The transition from PMC to Thrive Health represents a deliberate transformation aligned with Tarrant County Public Health’s broader effort to become a more efficient, high-performing public health system. The previous clinic identities no longer fully reflected the scope or impact of services being delivered, and the 35-year anniversary provides an appropriate moment to evolve into a more unified and forward-looking model.

This transformation is driven by a focus on improving operational efficiency, returning to a physician-centric model of care, and optimizing the use of existing staff to increase patient throughput and enhance care delivery. At its core, the redesign is aligned with the Triple Aim of Healthcare—improving quality, expanding access, and reducing costs.

From a quality perspective, Thrive Health is expanding preventive services, including increasing vaccination rates—particularly among HIV PrEP patients—and incorporating routine Pap smears for eligible women in the STD clinic who have not been screened within recommended intervals. From an access standpoint, the move toward a team-based care model is expected to increase patient volume and reduce barriers to care.

In parallel, several targeted care initiatives are being implemented. A Rapid Restart Program is being developed to identify patients who have been out of care for six months or longer, with coordinated efforts from front desk staff, patient navigators, and case managers to reconnect these individuals to care and to overcome barriers. For appropriate patients, providers will review prior records, order necessary labs, and facilitate expedited re-initiation of antiretroviral therapy, including the use of home-based care teams when appropriate.

Alongside expanded vaccination efforts, preventive care is being strengthened through the integration of cervical cancer screening. Thrive Health is initially focusing on high-risk populations such as patients on PrEP before scaling to broader clinic populations. Together, these initiatives represent a shift toward a more proactive, population health-driven model of care.

Launching the Tarrant County HIV Care Collaborative
While Thrive Health celebrates 35 years of service in Tarrant County, we recognize that this work cannot be done alone. Our success and longevity is built on strong partnerships with fellow Ryan White HIV providers, including JPS Healing Wings, CAN Community Health, and AIDS Healthcare Foundation.

To further strengthen these collaborations, Tarrant County Public Health is launching the Tarrant County Ryan White HIV Care Collaborative—a first-of-its-kind initiative bringing together Ryan White providers across the region. This collaborative will serve as a platform for regular discussions on local HIV trends, ongoing education in prevention and treatment, and enhanced coordination of care across systems. A central priority will be improving linkage-to-care efforts through closer integration with DSOP and epidemiology teams.

Together, this unified approach represents a critical step toward reducing HIV transmission and improving health outcomes across Tarrant County.

Looking Forward
Thrive Health’s legacy demonstrates that coordinated HIV care works. However, continued innovation, collaboration, and system redesign are essential to meet the evolving needs of our population.

The future of HIV care in Tarrant County will be found in collaborations that deliver high-value, patient-centered care that allow individuals to lead healthy, fulfilling lives. By working together, we can move closer to ending the HIV epidemic—one patient, one system, and one collaboration at a time—because when we work together, we thrive.

Beating the Stigma: The Challenges in Treating Substance Use Disorders

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the May/June 2026 issue of Tarrant County Physician.

By the time you all read this article, I hope you will have had a chance to listen to some of Tarrant County Medical Minute’s many interesting podcast episodes. I recently had the privilege of being invited as a guest on the podcast (you can find my episode here), which TCMS launched in 2025. It was fun, and I also found it to be an opportunity to continue to highlight mental health and advocacy. As I’ve mentioned before, mental health is marginalized and stigmatized but so essential to overall health. I appreciated the opportunity to talk about this on the podcast, fulfilling one of my promises to speak openly about mental health issues.

So, today we are going to talk about an even more stigmatized mental health issue—substance use disorders. They are far more common than many of us realize. According to the Substance Abuse and Mental Health Services Administration in their National Survey on Drug Use and Health in 2023–24, nearly 48 million Americans age 12 and older, or about one in six people, meet criteria for a substance use disorder in any given year.¹

Texas mirrors this national statistic. Alcohol use disorder accounts for the largest proportion, followed by drug use disorders involving marijuana, stimulants, opioids and more. State‑level estimates from the National Survey on Drug Use and Health indicate that roughly one out of seven Texans meets criteria for a substance use disorder each year.² While this is slightly lower than the national average, it still represents millions of people across our state whose health, relationships, and economic stability are affected. In a state as large and diverse as Texas, the collective impact of these conditions is substantial: it affects healthcare utilization, workforce participation, public safety, and even community well-being.

For physicians, this data shows what is already evident in clinical practice. Substance use disorders frequently coexist with chronic medical conditions, complicating diagnoses and treatments while increasing the risk of poor health outcomes. For legislators and policymakers, the numbers highlight the scope of the issue and the importance of continuous investment in prevention, early identification, evidence‑based treatment, and long‑term recovery support. And for the general public, the message is both sobering and illuminating: substance use disorders are common, treatable medical conditions, not moral failures or character flaws.

Substance use disorders do not exist in isolation. National data consistently demonstrates high rates of co‑occurring mental illness as well.¹ This overlap reinforces the need for integrated approaches to care that address the whole person rather than fragmented systems that separate “mental health” from “substance use.” The stigma surrounding substance use disorders mirrors the stigma that has historically marginalized mental health conditions—just as depression and anxiety were once dismissed as weaknesses rather than illnesses, substance use disorders continue to be judged rather than treated.

Stigma remains one of the most powerful barriers to care. It delays seeking help, discourages honest conversations between patients and physicians, and shapes policies that emphasize punishment over treatment. When individuals fear judgment, they are less likely to disclose substance use concerns, less likely to engage in treatment, and less likely to experience recovery. This is true no matter what walk of life you stem from, no matter what profession you are in. Reducing stigma is thus a clinical, ethical, and public health imperative.

Texas‑specific health data further illustrates the downstream effects of untreated substance use disorders, including alcohol‑related hospitalizations, drug‑related overdoses, and preventable deaths.² Even when prevalence rates are slightly lower than national averages, the absolute number of affected individuals places significant strain on healthcare systems and communities. These outcomes are not inevitable; evidence‑based prevention strategies, timely access to treatment, and sustained recovery supports have been shown to reduce morbidity, mortality, and costs.³ The key is that these initiatives have to be adequately funded and broadly accessible.

It is essential to treat substance use disorders as seriously and compassionately as other chronic illnesses. This includes speaking openly about prevalence, acknowledging the role of stigma, and advocating for systems of care that are based on scientific evidence rather than outdated assumptions. If one in six Americans—and one in seven Texans—are affected, then nearly every family, workplace, and community has a stake in how we respond. As physicians, policy advocates, and community leaders, we have both the opportunity and the responsibility to lead with data, compassion, and transparency. By reframing substance use disorders as the common, treatable health conditions they are, we can achieve these goals of reducing stigma, improving access to care, and improving the health and well-being of the populations we serve.

For physicians, the message should be clear: substance use disorders are common and addressing them as part of routine medical care should be best practice. Screening and brief, non-judgmental conversations about substance use should be normalized in our clinical settings. How we ask and how we respond do matter. Framing substance use disorders as treatable medical conditions like the evidence shows will increase patient disclosures, increase their engagement in treatment, and ultimately lead to their trust in us. We must lead the shift from judgment to treatment by insisting that substance use disorders are met with evidenced based care, equitable insurance coverage, and our compassion—not silence or shame.

“We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
– OPRAH WINFREY

References:

Blaire Bryant, Naomi Freel, and Emily Steckler, “SAMHSA Releases New 2024 Data on Rates of Mental Illness and Substance Use Disorder in the US,” National Association of Counties, July 28, 2025, https://www.naco.org/news/samhsa-releases-new-2024-data-rates-mental-illness-and-substance-use-disorder-us.
“Substance Use Disorder Statistics,” Drug Policy Facts, accessed May 4, 2026, https://www.drugpolicyfacts.org/node/4476.
Johanna Bellon et al., “Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US,” JAMA Network Open 5, no. 12 (2022): e2244644, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799220.
Substance Abuse and Mental Health Services Administration, “National Survey on Drug Use and Health (NSDUH): 2023 National Releases,” SAMHSA, accessed April 1, 2026, https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2023.
Substance Abuse and Mental Health Services Administration, “State Estimates of Mental Health and Substance Use,” accessed April 1, 2026, https://nsduhweb.rti.org/respweb/estimates.html.
Li-Tzy Wu, He Zhu, and Udi E. Ghitza, “Multicomorbidity of Chronic Diseases and Substance Use Disorders and Their Association with Hospitalization: Results from Electronic Health Records Data,” Drug and Alcohol Dependence 192 (2018): 316–23, https://doi.org/10.1016/j.drugalcdep.2018.08.013.
Lauren R. Ray et al., “Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis,” JAMA Network Open 3, no. 6 (2020): e208279, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767358.

Understanding Before Access: Why PATC Is Measuring Health Literacy More Intentionally

Project Access Tarrant County

By Kathryn Keaton

This article was originally published in the March/April 2026 issue of Tarrant County Physician.

At Project Access Tarrant County, we have always believed that the “access” in our name involves more than seeing a specialist—it also includes comprehension. A growing body of research confirms what community health organizations have long observed: Health literacy is directly tied to healthcare utilization, outcomes, and cost.

Health literacy, as defined by Healthy People 2030, is “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”¹ PATC is uniquely positioned to help our patients improve health literacy not just for their PATC service, but also for their future lifetime of healthcare.

A 2025 systematic review found that limited health literacy is consistently associated with higher healthcare costs, increased hospitalizations, and greater emergency department use—all areas PATC aims to reduce in Tarrant County.² Literacy is not a secondary social factor; it is a healthcare variable. Health literacy influences how patients navigate outpatient, inpatient, emergency, and digital health systems (even more so in immigrant populations)—and PATC is changing how we approach this issue in our patient base.

Moving Beyond “High School or Not”
Historically, many healthcare systems—including safety-net organizations—have captured each patient’s education level in broad terms. Emerging research shows that education level alone does not reliably predict a patient’s ability to understand medical terminology, consent forms, referral instructions, or post-procedure care plans. Studies have demonstrated that even patient-facing surgical materials are frequently written above recommended reading levels.

A decade ago, the AMA and National Institute of Health recommended that medical materials be written at an eighth grade or below reading level,³ but today, most experts agree that material should be written at a sixth grade or below reading level.⁴

When written information assumes advanced comprehension, patients are placed at risk of misunderstanding critical instructions. Just last year, a PATC patient almost canceled her vital surgery because she mistakenly thought she was instructed to stop her diabetes medication for a full week leading up to her surgery. She had enough health literacy to question those instructions, but not enough confidence to question their accuracy.

To respond more intentionally, PATC is refining how we capture and evaluate education and health literacy across our patient population.

What We’re Changing

Narrowing our educational ranges
Rather than broad categories, we now collect more targeted education data. This allows us to examine patterns in referral completion, adherence, and communication preferences.
Identifying whether education occurred inside or outside the United States
Educational systems vary widely across countries. A high school diploma earned abroad may reflect a different exposure to English-language healthcare terminology or system navigation. Recent national research examining health literacy by Hispanic ethnicity reinforces this nuance.⁵
Implementing SAHL evaluations for each adult patient

PATC is incorporating the Short Assessment of Health Literacy (SAHL), a validated screening tool created in 2010 by Health Services Research that directly measures a patient’s ability to recognize and understand common medical terms.

Unlike education level, SAHL evaluates functional comprehension—an essential factor in specialty care navigation. The tool is curated in both English and Spanish, with other languages available.⁶

Why Literacy Directly Impacts Care
Health literacy affects:

Medication adherence
Chronic disease management
Completion of specialty referrals
Understanding of pre-procedure instructions
Post-surgical recovery compliance

Systematic reviews across multiple countries show that lower health literacy is associated with delayed care, increased acute utilization, and poorer chronic disease management—even in universal healthcare systems, insurance coverage alone does not eliminate access barriers.⁷

For uninsured patients navigating specialty referrals—often involving multiple providers, consent forms, preparation instructions, and follow-up plans—comprehension is foundational. When literacy gaps are not identified, missed appointments may be labeled as “noncompliance.” In reality, they may reflect confusion, fear, or uncertainty.

Connecting Data to Our Broader Health Literacy Efforts
Importantly, PATC’s shift is not just about collecting more data. It strengthens and informs our broader health literacy initiatives, including:

Simplifying written instructions
Evaluating readability of patient-facing materials
Reinforcing clear text-based communications (CareMessage)
Informing topics for future Salud en Tus Manos curriculum
Literacy is not just a patient issue—it is a system design issue. By measuring literacy more intentionally, PATC can ensure that communication strategies match patient needs.

Access Requires Understanding
Healthcare systems are becoming increasingly complex and digital. Artificial intelligence tools, online portals, and automated communications can enhance access—but only if patients can understand and use them effectively.

Access to care is not complete when an appointment is scheduled. It is complete when a patient understands what that appointment means—and what to do next.

By refining how we measure education and incorporating validated literacy screening, PATC is strengthening the foundation of specialty care coordination—because access begins with understanding.

References:

Office of Disease Prevention and Health Promotion, “Health Literacy in Healthy People 2030,” Healthy People 2030, U.S. Department of Health and Human Services, accessed March 12, 2026, https://odphp.health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030.
Francesca Tusoni et al., “What Is the Impact of Health Literacy on Healthcare Costs? A Systematic Review and Evidence Synthesis,” BMJ Open 15, no. 12 (2025): e108816, https://bmjopen.bmj.com/content/15/12/e108816.
Patrick J. L. Fitzgerald et al., “Readability of Patient Education Materials on the American Association for Surgery of Trauma Website,” Journal of Surgical Research (2014), https://pmc.ncbi.nlm.nih.gov/articles/PMC4139691/.
Cheryl A. Tucker, “Promoting Personal Health Literacy Through Readability, Understandability, and Actionability of Online Patient Education Materials,” Journal of the American Heart Association 13, no. 8 (2024): e033916, https://www.ahajournals.org/doi/10.1161/JAHA.124.033916.
Athena K. Ramos et al., “Health Literacy by Hispanic Ethnicity and its Association with Healthcare Experiences, Self-rated Health, and Quality of Life,” Journal of Immigrant and Minority Health (2026), https://doi.org/10.1007/s10903-026-01848-5.
Shoou-Yih Daniel Lee et al., “Short Assessment of Health Literacy—Spanish and English,” Health Services Research 45, no. 4 (2010): 1105–1120, https://doi.org/10.1111/j.1475-6773.2010.01119.x.
R Schönegger, C Von Reibnitz, and Hans-Peter Wiesinger, “Health Literacy and Healthcare Utilisation in Universal Healthcare Systems: A Systematic Review,” European Journal of Public Health 35, no. 4 (October 2025), https://doi.org/10.1093/eurpub/ckaf161.1476.

The Winter Blues

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the March/April 2026 issue of Tarrant County Physician.

As I was first writing this article, we were facing our usual “once a winter” storm with freezing temperatures, snow, and ice. Despite our best preparations, Texas just does not have the infrastructure to maintain business as usual during significant winter storms. Honestly, up to this point, it seemed like a pretty mild winter. And then the front came through with howling winds, record low temperatures, freezing rain that turned to sleet, and barely any snow, though some did fall. People stayed indoors in the warmth, but many I am sure enjoyed some “winter sports” with sledding on trash can lids and attempts to build snowmen.

However, it didn’t take long before people started feeling cooped up and wanting to get out. Thanks to telehealth, my clinic was able to provide care for patients during the following week while we awaited sunnier days and above-freezing temperatures. Patients were already mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets in. It happens only now and again, when people may want to stay home but still are interested in their usual activities. This is not seasonal affective disorder, a serious variant of clinical depression that often requires professional treatment. This is a fairly well-known phenomenon called “winter blues.” NIH-funded researchers have been studying both of these conditions for decades.

Patients were . . . mentioning that they felt a dip in their mood and lower motivation. Friends, family, and acquaintances over the years have sometimes mentioned things like this when the winter sets it. . . . This is a fairly well-known phenomenon called “winter blues.”

The winter blues tend to occur in colder and more northern (or southern if south of the equator) areas because it is a reaction to reduced sunlight and the changes of the season. Yet it can happen anywhere when the weather turns “dark and dreary.” According to the University of California-Davis Health, people still continue to function while experiencing a mood dip, minimal sadness, fatigue, and less motivation.¹ These feelings are usually mild and temporary, which is different from seasonal affective disorder. According to Dr. Matthew Rudorfer, an NIH mental health expert, the winter blues can be linked to something specific, like holiday stress or loss.²

What should we do or recommend if we or those around us have the snowy doldrums? It may seem obvious, but simple things like getting outside (dress appropriately!), opening your blinds/curtains for more ambient light, being social, and getting physical (the Jane Fonda kind, not the Mike Tyson kind) are all ways to get past this. The kids have it right—go sledding, have snowball fights, make a snow (or ice) man . . . and enjoy some hot cocoa when it’s time to relax. Because the seasons always change, and spring is on the way! Well, technically, in Texas, it’s already here.

References:

UC Davis Health, “Seasonal Affective Disorder, Winter Blues and Self-Care Tips to Get Ahead of Symptoms,” Cultivating Health (UC Davis Health Blog), November 29, 2023, https://health.ucdavis.edu/blog/cultivating-health/seasonal-affective-disorder-winter-blues-and-self-care-tips-to-get-ahead-of-symptoms/2023/11.
“Beating the Winter Blues,” NIH News in Health, January 2013, https://newsinhealth.nih.gov/2013/01/beating-winter-blues.

Mental Health in Medicine: A Call to Lead

President’s Paragraph

By Cheryl Hurd, MD, TCMS President

This article was originally published in the January/February 2026 issue of Tarrant County Physician.

Hello everyone, my name is Cheryl Hurd, and it is my honor and privilege to serve as the 2026 TCMS president. I am a psychiatrist who has been in active practice for nearly twenty-five years, but I have also been a medical educator for the majority of that time. (I am also an English Lit major, so the “President’s Paragraph” is likely to become much longer than a paragraph. . . .) I want to thank the many presidents before me who have written articles and stories that have amused, enlightened, and inspired me. I admire the passion (and compassion) as well as the courage of my predecessors. I can only hope to aspire to the same level of dedication to my theme as they did to theirs.

My mission has always been to provide the highest quality and evidenced-based care to patients while training the next generation of physicians in best practices. Easy buzzwords to write, but they’re sincere nonetheless. As a psychiatrist, mental health is at the forefront of my mind. Mental health has long been marginalized, treated as secondary to physical illness, and burdened by stigma. Yet the evidence is clear: Mental health is inseparable from overall health, and its neglect undermines our patients, our communities, and ourselves.

I have chosen to make mental health advocacy the defining theme of my tenure. This is not just a matter of professional responsibility; it is a moral imperative. TCMS should be among those leading the way in ensuring that mental health is recognized as a cornerstone of care in this county and throughout the great state of Texas.

Millions of people struggle with depression, anxiety, trauma, and substance misuse; this includes us as physicians. Suicide remains a leading cause of death among young people, and burnout continues to erode the well-being of healthcare professionals. We still lose as many as 400 attending physicians to suicide a year.¹ Residents and medical students are facing the same challenges. These realities are not just statistics—they are the lived experiences of our patients, colleagues, families, and ourselves.

The pandemic further exposed the fragility of our mental health infrastructure. The sequelae of the pandemic included an explosion in mental health disorders across our country. Demand for services surged, yet access remained uneven despite the adoption of telepsychiatry. Rural communities, marginalized populations, and children bore disproportionate burdens. I was president of the medical staff at JPS from the beginning through the height of the pandemic, and I saw firsthand the devastation that was wrought on the physical and mental well-being of the healthcare workforce. My most important service as medical staff president during that time was to bolster our physicians and other providers, provide resources, give updates, and instill hope when despair seemed to overwhelm us. The infrastructure could not meet the demands, and it often still doesn’t.

So, I would like to focus on expanding equitable access to care for all; integrating mental health into primary care, schools, and workplaces; and leading a conversational shift that normalizes open discussions about mental health across our practices and communities. Through advocacy we can advance reforms that treat mental health with the same seriousness as physical illness, expand the workforce with training and support for all physicians (not just mandate PHQ-9 and GAD-7 questionnaires at every visit), strengthen school partnerships to provide early intervention, invest in community clinics, expand telehealth to close gaps in underserved areas, and promote research and innovation that drive evidence‑based solutions.

As physicians, we still carry unique credibility in shaping public discourse. When we speak openly about mental health—whether in clinical settings, community forums, policy debates, or even podcasts—we dismantle stigma and inspire change.

We must also look inward. Physician burnout and moral distress remain pressing concerns that negatively impact physician well-being. By prioritizing mental health within our own profession, we model resilience and compassion for the broader healthcare system. TMA, our state medical association, has developed many resources in service of our members for these very issues. Many county societies have done the same, as have we at TCMS. I encourage everyone to visit the Physician Wellness website and learn more about our efforts: https://www.tcam.org/physician-wellness.

I know that I am asking a lot of all of you, and it won’t be easy. There are many financial constraints and competing interests that limit the expansion of services. We have a workforce shortage that hinders access, and the stigma of mental illness persists (particularly when it is related to substance use disorders). Differences in healthcare policies and funding priorities can complicate efforts to expand mental health services, but collaboration can help bridge these divides. These challenges are not insurmountable. With advocacy, innovation, and determination, we can overcome them.

Mental health is about people. It is about the child struggling with anxiety, the veteran coping with trauma, the parent balancing stress, and the physician facing burnout. By focusing on mental health, we confirm that every individual’s well-being matters.

As president of our medical society, I call upon each of you—physicians, educators, researchers, and advocates—to join me in this work. Together, we can elevate mental health, ensuring that it is recognized as a fundamental component of healthiness and a shared responsibility of the medical community.

“What mental health needs is more sunlight, more candor, and more unashamed conversation.” —Glenn Close

References:

John Matheson, “Physician Suicide,” American College of Emergency Physicians https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide#:~:text=Each%20year%20in%20the%20U.S.,and%20alcohol%20and%20substance%20abuse;.

Tarrant County Public Health: Health Advisory Alert

An original message by Tarrant County Public Health announced on June 9, 2023.

Tarrant County Public Health (TCPH) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians about a confirmed measles case in a Hood County resident in a Tarrant County Hospital. TCPH has worked closely with the facility to identify exposure to some patients and staff that occurred before measles was suspected. All exposed people have been contacted and advised to watch for signs and symptoms through June 22nd. TCPH collaborated with the facility and Texas Department of State Health Services (DSHS), to investigate and respond to this measles case and exposures.

Below is a forwarded HAN from DSHS with background information about the current measles case, information on measles and the importance of early recognition, diagnosis, and appropriate treatment. TCPH recommends that clinicians be on the alert for cases of measles that meet the case definition.

Due to the highly contagious nature of this disease, additional cases may occur. We advise clinicians to follow the recommendations below and report any suspected cases immediately to Tarrant County Public Health’s 24-hour reporting line at (817)321-5350, preferably while the patient is present.

Background

A young child who is a resident of Hood County was recently diagnosed with measles. The child had no history of travel to an area where measles is spreading and no known exposure to a person with measles. The child has been treated and is recovering.

This is the first confirmed case of measles in Texas since travel-related outbreaks in 2019, which led to 23 cases. Completion of the two-dose series of the measles vaccine is highly effective at preventing measles, however even vaccinated people may occasionally become infected.

Measles is a highly contagious respiratory illness. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. The illness usually starts a week or two after someone is exposed with symptoms like a high fever, cough, runny nose and red, watery eyes. A few days later, the telltale rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after. People with measles should stay home from work or school during that period.

The best way to prevent getting sick is to be immunized with two doses of the measles- containing vaccine, which is primarily administered as the combination of measles-mumps- rubella (MMR) vaccine. DSHS and the Centers for Disease Control and Prevention recommend children receive one dose at 12 to 15 months of age and another at 4 to 6 years. Children too young to be vaccinated or who have only had one dose of vaccine are more likely to get infected and more likely to have severe complications if they do get sick.

Recommendations For Health Care Professionals:

Healthcare providers should consider measles in patients presenting with the following symptoms, particularly those who have traveled abroad or had contact with known measles cases:

• Fever ≥101°F (38.3°C) AND
• Generalized maculopapular rash lasting ≥3 days AND Rash begins at the hairline/scalp and progresses down the body
• Cough, runny nose, conjunctivitis OR Koplik spots (bluish-white specks or a red-rose background appearing on the buccal and labial mucosa usually opposite the molars)

Immediately report any suspected cases of measles to Tarrant County Public Health at our 24 hour hotline (817)321-5350) (dshs.texas.gov/idcu/investigation/conditions/contacts). If possible, please report while the patient is present to facilitate testing and the public health investigation, including follow-up of potential exposures.

Infection Control Precautions

Airborne precautious should be followed to reduce possible exposures in healthcare settings.
In urgent/emergency healthcare settings, suspected cases should be masked with a surgical mask and triaged quickly from waiting areas into a room with a closed door, airborne isolation precautions recommended. In other outpatient settings, suspected cases should be scheduled at the end of the day, if possible. Healthcare workers caring for patients suspected of having measles should use airborne infection control precautions. (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html)
Since measles is so highly transmissible and can spread in health care settings, people who work in places like a doctor’s office or emergency room should have evidence of measles immunity to prevent any potential outbreak. (https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07- measles.html#f21).

Diagnostic Testing

Testing for measles should be done for all suspected cases of measles at the time of the initial medical visit:
Measles PCR and serology (IgM and IgG) testing is available at both the Texas DSHS Laboratory in Austin and at commercial laboratories.
The Texas DSHS Laboratory can perform PCR testing on throat swabs (preferred) or nasopharyngeal swabs placed in viral transport media and serology on serum specimens.
DSHS strongly encourages providers to submit PCR specimens to the DSHS Laboratory because genotyping will be performed on positive PCR specimens, which can be helpful during outbreaks.
Providers should work with their local health department or DSHS regional office to coordinate testing at the DSHS laboratory to ensure specimens are submitted correctly and meet testing requirements.
Unless coordinated in advance, specimens may only be received during normal business hours Monday through Friday.

Recommendations for Public Health:

Control and Prevention Measures

Measles vaccination may prevent disease in exposed people if given within 72 hours of exposure. People 6 months and older who have not been fully vaccinated would be eligible for vaccination under those circumstances. It may provide some long-term protection but should be followed with a second vaccination at least one month later. Immune globulin (IG) may be indicated for some people but should not be used to control an outbreak.
Pregnant women, people with severe immunosuppression, and anyone with a previous anaphylactic reaction to a vaccine component should not get a measles vaccine.

Controlling Outbreaks in Group Settings

People with confirmed or suspected measles should stay home from school, work, and other group settings until after the fourth day of rash onset.
During an outbreak, people without documented immunity from vaccination or previous measles infection should be isolated from anyone with measles to protect those without immunity and control the outbreak. Additional information on school exclusion and readmission can be found at dshs.texas.gov/idps- home/school-communicable-disease-chart

Recommendations for the Public

If you think you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider before arriving to be tested so they can prepare for your arrival without exposing other people to the virus. Measles is extremely contagious and can cause life-threatening illness to anyone who is not protected against the virus.

For More Information: