Showing papers by "South Carolina Department of Health and Environmental Control published in 2007"

Understanding Barriers for Adherence to Follow-Up Care for Abnormal Pap Tests

Abstract: Objective: Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions to decrease morbidity and mortality due to cervical cancer. Methods: We conducted a comprehensive search of published literature addressing risk factors for adherence or interventions to improve adherence following an abnormal Pap test as the outcome. We included peer-reviewed original research conducted in the United States from 1990 to 2005. Results: Fourteen analytical and twelve experimental studies that met our criteria were reviewed. Lesion severity and health beliefs were consistently associated with adherence rates. Communication interventions, including telephone reminders, counseling, and educational sessions, increased follow-up co...

Importance of prudent antibiotic use on dairy farms in South Carolina: a pilot project on farmers' knowledge, attitudes and practices.

Abstract: Inappropriate use of antibiotics in humans and animals contributes to decreased antimicrobial susceptibility in bacteria of medical importance. Resistant bacteria being transferred from animals to humans are causing public health concern. In-person interviews were conducted with 20 dairy farmers in rural counties of South Carolina to determine farmers' knowledge and attitudes about prudent antibiotic use among livestock. Four focus groups (n = 22) were also conducted to ascertain farmers' specific information needs about proper antibiotic use. Survey results showed that participants (100%) typically determined a need for antibiotic treatment using symptom assessment and reported following some form of operating procedures regarding administration of antibiotics. Few farmers (32%) had actual written antibiotic protocols. Preferred information sources about antibiotics were veterinarians (100%) and other dairy farmers (50%). Most farmers (86%) were not concerned that overuse of antibiotics in animals could result in antibiotic resistance among farm workers. Qualitative analysis of focus groups revealed significant barriers to following proper antibiotic procedures including limited finances and lack of time. The need for bilingual educational resources for Hispanic/Latino dairy workers was expressed. Desired formats for educational materials were posters, flowcharts, videos, and seminars. Education of South Carolina dairy farmers by veterinarians and public health professionals on the appropriate use of antibiotics in dairy cattle is needed to ensure antibiotic effectiveness in both animals and humans.

Rapid Assessment of Exposure to Chlorine Released from a Train Derailment and Resulting Health Impact

Abstract: OBJECTIVES: After a train derailment released approximately 60 tons of chlorine from a ruptured tanker car, a multiagency team performed a rapid assessment of the health impact to determine morbidity caused by the chlorine and evaluate the effect of this mass-casualty event on health-care facilities METHODS: A case was defined as death or illness related to chlorine exposure Investigators gathered information on exposure, treatment received, and outcome through patient questionnaires and medical record review An exposure severity rating was assigned to each patient based on description of exposure, distance from derailment, and duration of exposure A case involving death or hospitalization > or = 3 nights was classified as a severe medical outcome Logistic regression was used to examine factors associated with severe medical outcomes RESULTS: Nine people died, 72 were hospitalized in nine hospitals, and 525 were examined as outpatients Fifty-one people (8%) had a severe medical outcome Of 263 emergency department visits within 24 hours of the incident, 146 (56%) were in Augusta, Georgia; at least 95 patients arrived at facilities in privately owned vehicles Patients with moderate-to-extreme exposure were more likely to experience a severe medical outcome (relative risk: 152; 95% confidence interval 48, 478) than those with a lower rating CONCLUSIONS: The rapid investigation revealed significant morbidity and mortality associated with an accidental release of chlorine gas Key findings that should be addressed during facility, community, state, and regional mass-casualty planning include self-transport of symptomatic people for medical care and impact on health-care facilities over a wide geographic area Language: en

Along channel flow and sediment dynamics at North Inlet, South Carolina

Abstract: In May of 2005, an observational program was carried out to investigate the along channel hydrodynamics and suspended sediment transport patterns at North Inlet, South Carolina. Along channel variability, which is important in establishing sediment transport pathways, has not been characterized for this system. Measurements of water column currents, salinity, bed sediment, suspended sediment concentration, and particle size distribution were obtained over a complete tidal cycle along the thalweg of the inlet entrance. Along channel currents, shear stress and bed sediment distributions vary significantly in space and time along a 3 km section bracketing the inlet throat. Most of the variability is consistent with geomorphic controls such as bed elevation variability and channel width. The highest velocities, shear stresses, suspended sediment concentration and bed sediment grain size are observed in the narrowest section of the inlet throat. Magnitudes systematically decrease along the channel toward the marsh as changes in channel geometry and branching reduces flow energy. Due to tidal asymmetry, the ebb phase contains significantly higher currents and associated sediment transport. Over the complete tidal cycle, depth integrated transport is directed towards the marsh landward of the intersection of Town and Debidue Creek. In contrast, net transport is out of the inlet seaward of this intersection. Sediment grain size distributions show 35% more material less than 63 μm on flood, suggesting net landward transport of fines.

Immunologic, virologic, and neuropsychologic responses in human immunodeficiency virus-infected children receiving their first highly active antiretroviral therapy regimen.

Abstract: Our objective was to measure the early dynamics, evolution, and durability over 96 wk of immunologic responses in children receiving their first highly active antiretroviral therapy (HAART) regimen. The study was designed as a prospective, single-arm study. Twelve human immunodeficiency virus (HIV)-infected children (median age, 11.8 yr) were enrolled. All subjects received stavudine, nevirapine, and ritonavir. Serial measurements included HIV viral load, lymphocyte subsets, thymic volume by computed tomography (CT), neurocognitive testing, and brain CT. Baseline median CD4(+) T cell count was 589 cells/mm(3) , viral load was 3.9 log(10) HIV RNA copies/mL, and thymic volume was 16.3 cm(3) . Ten children had an undetectable viral load at week 48. Eight maintained an undetectable viral load at 96 wk. The median increase in absolute CD4(+) T cell count was 225 cells/mm(3) by week 48, and 307 cells/mm(3) by week 96. The median increase in naive (CD45RA(+) CD62L(+) ) CD4(+) T cells was 133 cells/mm(3) by week 48, and 147 cells/mm(3) by week 96. The median number of naive CD8(+) T cells increased from 205 to 284 cells/mm(3) by week 24; this increase was sustained to week 96. The number of B cells increased and was associated with a decrease in immunoglobulin levels. The number of natural killer cells was stable. There were no significant changes in thymic volume. Most children exhibited stable cognitive function over the course of the study. We conclude that, in this cohort of relatively immunocompetent HIV-infected children, an initial HAART regimen was associated with rapid and sustained increases in total CD4(+) T cells, in naive CD4(+) and CD8(+) T cells, and in B cells through 96 wk.

Panel classification of self-reported exposure histories: a useful exposure index after a mass-casualty event.

Abstract: OBJECTIVE: Although rapid epidemiologic investigations of toxic exposures require estimates of individual exposure levels, objective measures of exposure are often unavailable. We investigated whether self-reported exposure histories, when reviewed and classified by a panel of raters, provided a useful exposure metric. METHODS: A panel reviewed exposure histories as reported by people who experienced a chlorine release. The panelists received no information about health-care requirements or specific health effects. To each exposure case, each panelist assigned one of five possible exposure severity ratings. When assigned ratings were not in initial agreement, the panelists discussed the case and assigned a consensus rating. Percent agreement and kappa statistics assessed agreement among panelists, Kendall's W measured agreement among panelists in their overall ordering of the exposure histories, and Spearman's rho compared the resultant rankings with individual health outcome. RESULTS: In 48% of the cases, the panelists' initial ratings agreed completely. Overall, initial ratings for a given case matched the consensus rating 69% to 89% of the time. Pair-wise comparisons revealed 85% to 95% agreement among panelists, with weighted kappa statistics between 0.69 and 0.83. In their overall ranking of the exposure histories, the panelists reached significant agreement (W = 0.90, p Language: en

Remediation process optimization: A status report

Abstract: There are hundreds of contaminated sites with remediation systems that require evaluation and modification to accomplish cleanup goals. These systems are operating well past projected cleanup schedules, cost more than projected to operate, and may not be as protective of human health and the environment as planned. Remediation process optimization (RPO) is an effective method to assess the progress of a system toward achieving cleanup goals within desired time frames and to make the necessary changes in order to reach those goals. Eight main components to the RPO process are evaluated during a review and an implementation plan of recommended changes to the system is developed. Follow-up and tracking are essential to successful RPO programs. In this article, the authors present a summary of a recent Technical and Regulatory (TechReg) Guidance Document (Interstate Technology and Regulatory Council [ITRC], 2004) and related Technology Overview Series on Advanced Topics in RPO (ITRC, 2006) in a distilled form. © 2007 Wiley Periodicals, Inc.

The role of health departments in advancing a new community health and wellness agenda.

Abstract: The National Expert Panel on Community Health Promotion provided recommendations that are relevant not only to federal agencies such as the Centers for Disease Control and Prevention (CDC) but also to state and local health agencies (1) State and local health agencies have a strong foundation in convening nontraditional partners, coordinating public and private efforts, and serving as a model for accountability and stewardship These skills can be used to apply the principles outlined by the expert panel, including expanding surveillance systems to include social determinants of health and developing programs within the context of local culture and political processes Public health agencies must begin to develop surveillance measures of the socioecological determinants of health by seeking expertise in sociology, economics, and other sciences With expanded surveillance measures, we in public health can determine how social factors influence prevention and management of chronic diseases We can develop methods to define, quantify, measure, and weigh these socioecological indicators and establish benchmarks for these determinants of health and disease This information will be critical to the design of effective strategies that target the social precursors of disease and to the measurement of the impact of these strategies on both social and health variables Some communities, such as King County, Washington, have included social and health indicators in tracking the well-being of residents and improvements in community health (2) State and local health agencies also have a role in developing public health programs in collaboration with community members and stakeholders and in coordinating these efforts to directly address community health concerns As outlined in the expert panel report, true community engagement is needed to sustain chronic disease prevention activities over time This approach is also evident in the tool Mobilizing for Action through Planning and Partnerships developed by the National Association of County and City Health Officials in cooperation with the Public Health Practice Program Office, CDC (3) Evidence linking socioecological factors to health will help bring new partners and community participation to public health when it becomes clear that our interests overlap New surveillance tools will help us recognize social and ecological problems, predict their public health impact, and plan for long-term public health solutions involving both the public and private sectors The expected improvement in community health can contribute to higher education levels, improved productivity, and improved earning capacity As health departments balance their focus on immediate health concerns with long-term community health, they will need to build the skills of an interdisciplinary workforce to meet the public health challenges of the future The Institute of Medicine's report Who Will Keep the Public Healthy? promotes an ecological approach to addressing public health challenges in the 21st century (4) It states that public health professionals must have a framework for action, an understanding of the forces that affect health, and a model of health that emphasizes the linkages and relationships among multiple determinants affecting health It goes on to recommend that public health agencies assess their workforce development needs, collaborate with schools of public health, and assure that their leadership has experience in the ecological approach to public health The expert panel made a strong recommendation to the National Center for Chronic Disease Prevention and Health Promotion to support training and capacity building to ensure that the public health workforce has the knowledge, skills, and tools to implement community health promotion approaches These capacities may include sustainability, program evaluation, and socioecological dimensions of health The Directors of Health Promotion and Education and the National Association of Chronic Disease Directors are devoting significant resources to assess training needs, provide relevant training opportunities, and expand the focus of community health training to address this recommendation Many public health agencies are taking advantage of new technologies to develop their existing workforce Distance learning via satellite transmissions, webcasts, self-instruction using DVDs, and other new methods has provided access to quality continuing education even in rural areas Public health agencies need to ensure that application of the socioecological model is included in determining the capacity of their workforce and that trainings are offered to build skills in using the model Public health agencies must also disseminate best practices and lessons learned in applying these skills through traditional and nontraditional means as part of the larger framework of public health workforce development