Climate Change and Public Health through the Lens of Rural, Eastern North Carolina.

Recognizing that health outcomes are associated with climate threats is important and requires increased attention by health care providers and policymakers. The primary goal of this report is to provide information related to the public health threats of climate change, while identifying climate-sensitive populations primarily in rural, Eastern North Carolina. Publicly available data was used to evaluate regional (eg, Eastern, Piedmont, and Western) and county level socio-vulnerability characteristics of population groups in North Carolina, including: percent of persons living in poverty, percent of non-white persons, percent of persons under 18 years living in poverty, percent of elderly people living in poverty, percent of persons with a disability, and number of primary care physicians.

Outbreak of Mycobacterium mucogenicum bloodstream infections among patients with sickle cell disease in an outpatient setting.

Objective: To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting.

Design: Outbreak investigation and retrospective chart review.

Setting: University outpatient clinic.

Human health effects of exposure to Pfiesteria piscicida: a review.

Since its identification, the dinoflagellate Pfiesteria piscicida has been implicated in fish kills and fish disease in the southeastern United States. Adverse health effects have been reported in researchers working with the organism and in watermen following exposure to a fish kill in Maryland. A bioactive secretion is postulated as the cause of these effects but has not yet been isolated and chemically characterized.

Human visual function in the North Carolina clinical study on possible estuary-associated syndrome.

The U.S. Environmental Protection Agency assisted the North Carolina Department of Health and Human Services in conducting a study to investigate the potential for an association between fish kills in the North Carolina estuary system and the risk for persistent health effects.

Estuary-associated syndrome in North Carolina: an occupational prevalence study.

Atlantic coast estuaries recently have experienced fish kills and fish with lesions attributed to Pfiesteria piscicida and related dinoflagellates. Human health effects have been reported from laboratory exposure and from a 1997 Maryland fish kill. North Carolina has recorded Pfiesteria-related fish kill events over the past decade, but human health effects from environmental exposure have not been systematically investigated or documented here.

Prevalence of positive tuberculin skin reactions in a two-step testing program at a tertiary-care center in eastern North Carolina.

The results of performing two-step tuberculin skin testing of healthcare workers at a hospital in eastern North Carolina in 1997 and 1998 were reviewed. Of 1,248 new employees, approximately 500 required two-step testing, which identified only 5 new employees who might have been falsely labeled as converters during the subsequent year's surveillance testing.

Occupational infections in health care workers: prevention and intervention.

Health care workers may be exposed to a variety of infections as they carry out their job responsibilities. Guidelines have been issued for prophylaxis following exposure to blood or body fluids known to be infected with the human immunodeficiency virus. Hepatitis B vaccine must be offered to all workers who may be exposed to blood and body fluids.

Practice satisfaction among young West Virginia family physicians.

Young family physicians, those in their first five years of practice, were surveyed to determine their satisfaction regarding various aspects of their practices. A total of 67% of the physicians surveyed responded and the results indicated that most family doctors located in communities where there was a perceived need for their specialty. The survey also showed that two of the most important factors necessary to attract and retain family doctors in rural practice are enhanced third-party reimbursement and the availability of other family physicians to share call.

A comparison of uterine cervical cytology and biopsy results: indications and outcomes for colposcopy.

Background: There is some debate in the literature over the proper approach to the patient with a mildly abnormal cervical cytologic finding. One current approach for handling low-grade cytologic abnormalities is to perform colposcopy and biopsy if atypia, human papillomavirus (HPV) changes, or mild dysplasia is noted on cytologic examination. If a Papanicolaou (Pap) smear shows inflammation without atypia, the test is repeated after 3 months, and if inflammation does not clear, colposcopy is performed.

Why do patients decline screening mammography?

Physician recommendation may not be sufficient to motivate patients to comply with health maintenance activities. During a physician visit, female patients over age 50 were reminded to schedule mammography; more than 10% overtly refused. A telephone questionnaire of 20 age-matched refusers and compliers was performed to assess knowledge, attitudes, behavior, and demographics.

Adolescent perceptions of teenage morbidity and mortality in a rural population.

Health-related questionnaires were administered to 742 high school seniors in small towns in rural West Virginia. Students tended to overestimate the immediate threat to their health from cancer, heart disease and AIDS. They recognized a threat from auto accidents to their life and health in the immediate future, but nevertheless indulged in high-risk drinking and driving behavior.

The effect of doxycycline on serum levels of ethinyl estradiol, norethindrone, and endogenous progesterone.

Doxycycline and other antibiotics have been implicated in oral contraceptive (OC) failure, but information is sparse and studies of a doxycycline-OC interaction are nonexistent. Because an interaction between doxycycline and OCs, especially those containing low-dose estrogen, could result in an unplanned and unwanted pregnancy, a controlled clinical trial of the effects of doxycycline on OC hormone concentrations was performed. Twenty-four women aged 18-35 years were recruited as volunteers from among the patients seen in a University-based family planning clinic.

Estrogen replacement therapy: a pilot survey of primary care physicians in West Virginia.

Controversy surrounds the optimal use of estrogen replacement therapy (ERT) for the management of vasomotor instability and other perimenopausal symptoms. This fact and the obvious lack of published literature regarding physician prescribing behavior led the investigators to explore these issues with primary care physicians in West Virginia. Data were collected using a mailed, self-administered questionnaire.

Prevalence of Chlamydia trachomatis cervical infection in a college gynecology clinic: relationship to other infections and clinical features.

A total of 479 sexually active college women presenting for routine gynecologic care were screened for gonorrheal and chlamydial infection of the cervix. Most of these women were asymptomatic; those with symptoms had minor complaints related to the lower genital tract. A direct fluorescent antibody test (DFA) showed the prevalence of chlamydial infection to be 8.

Clinical aspects of genital herpes.

The clinical course is highly variable. The chance of recurrence is about 60 percent. Patients are infectious when lesions are present and, to a lesser extent, when asymptomatic virus shedding occurs.