PubMed Health⌕ Search

Biomedical subjects

M Swinker

Publications and source records attributed to M Swinker.

16 recordsLinked to original sources
PubMed2001

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. Impetus for the study was recent evidence suggesting that estuarine dinoflagellates, including members of the toxic Pfiesteria complex (TPC), P. piscicida and P. schumwayae, may release a toxin(s) that kills fish and adversely affects human health. This report describes one component of the study in which visual system function was assessed. Participants working primarily in estuaries inhabited by TPC or in off-shore waters thought not to contain TPC were studied. The potentially exposed estuary (n = 22) and unexposed offshore (n = 20) workers were matched for age, gender, and education. Visual acuity did not differ significantly between the cohorts, but visual contrast sensitivity (VCS), an indicator of visual pattern-detection ability for stimuli of various sizes, was significantly reduced by about 30% in the estuary relative to the offshore cohort. A further analysis that excluded participants having a history possibly predictive of neuropsychological impairment showed a similar VCS reduction. Additional analyses indicated that differences between the cohorts in age, education, smoking, alcohol consumption, and total time spent on any water did not account for the difference in VCS. Exploratory analyses suggested a possible association between the magnitude of VCS reduction and hours spent in contact with a fish kill. The profile of VCS deficit across stimulus sizes resembled that seen in organic solvent-exposed workers, but an assessment of occupational solvent, and other neurotoxicant, exposures did not indicate differences between the cohorts. These results suggest that factor(s) associated with the North Carolina estuaries, including the possibility of exposure to TPC toxin(s), may impair visual system function.

Analysis of Variance↗
PubMed2001

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. At the request of the state health agency, comprehensive examinations were conducted in a cross-sectional prevalence study of watermen working where Pfiesteria exposure may occur: waters where diseased or stressed fish were reported from June to September 1997, and where Pfiesteria had been identified in the past. Controls worked on unaffected waterways. The study was conducted 3 months after the last documented Pfiesteria-related fish kill. The goal was to document any persistent health effects from recent or remote contact with fish kills, fish with lesions, or affected waterways, using the 1997 U.S. Centers for Disease Control and Prevention case description for estuary-associated syndrome (EAS). Examinations included comprehensive medical, occupational, and environmental history, general medical, dermatologic, and neurologic examinations, vision testing, and neuropsychologic evaluations. Seventeen of 22 watermen working in affected waters and 11 of 21 in unaffected waters reported exposure to a fish kill or to fish with lesions. We found no pattern of abnormalities on medical, neurologic, neuropsychologic, or NES-2 evaluation. By history, one subject in each group met the EAS criteria, neither of whom had significant neuropsychological impairment when examined. Watermen from affected waterways had a significant reduction in visual contrast sensitivity (VCS) at the midspatial frequencies, but we did not identify a specific factor or exposure associated with this reduction. The cohorts did not differ in reported occupational exposure to solvents (qualitative) or to other neurotoxicants; however, exposure history was not sufficiently detailed to measure or control for solvent exposure. This small prevalence study in watermen, conducted 3 months after the last documented fish kill related to Pfiesteria, did not identify an increased risk of estuary-associated syndrome in those working on affected waterways. A significant difference between the estuary and ocean watermen was found on VCS, which could not be attributed to any specific factor or exposure. VCS may be affected by chemicals, drugs, alcohol, and several developmental and degenerative conditions; it has not been validated as being affected by known exposure to dinoflagellate secretions. VCS should be considered for inclusion in further studies, together with documentation or quantification of its potential confounders, to assess whether it has utility in relationship to dinoflagellate exposure.

Adult↗
PubMed2000

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.

Adult↗
PubMed1997

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. Chemoprophylaxis is not available for workers exposed to hepatitis C. Health care facilities must conduct a tuberculosis risk assessment, provide skin testing at least yearly and develop isolation procedures for potentially infectious patients. The Occupational Safety and Health Administration currently mandates two-stage skin testing for all new employees at risk for tuberculosis exposure who have not had a skin test in the past year. Recent skin-test converters should be evaluated for isoniazid prophylaxis after a chest radiograph rules out active tuberculosis. Workers should be removed from the workplace from days 10 to 21 following exposure to varicella infection; vaccination of nonimmune workers should be considered. Because of possible side effects, the standard pertussis vaccine is not used in adults, but a new acellular pertussis vaccine has been effective in this group.

Cross Infection↗
PubMed1994

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. This study was undertaken to determine whether the above recommendations are appropriate. METHODS: In a 1-year period, 125 patients underwent colposcopy and biopsy. Results were reviewed and compared. RESULTS: Of 47 patients with smears showing human papillomavirus (HPV) changes, 68% had a higher grade abnormality (dysplasia) on biopsy; 15% had moderate or severe dysplasia. Of eight patients with atypia, 63% had dysplasia on biopsy. Of 41 patients with mild dysplasia on Pap smear, 37% had moderate dysplasia or higher grade disease on biopsy. Of nine patients with persistent inflammation on cytologic examination, biopsy showed 56% with inflammation, 33% with mild dysplasia, and 11% normal. CONCLUSIONS: Patients who presented with minimal Pap smear abnormalities such as HPV changes or atypia are likely to have a worse histologic diagnosis, with approximately two thirds showing dysplasia. Patients with persistent inflammation are less likely to have dysplasia. The results support our aggressive approach toward minimally abnormal smears and our consideration of inflammation without atypia as a separate and lower risk category.

Biopsy↗
PubMed1993

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. Refusers and compliers were similar in many respects; there was no significant difference in how the groups perceived their current health. Paradoxically, refusers had less knowledge of bad experiences with mammograms (p < .01). Refusers were more likely not to know if their insurance covered screening (p < .01), and were less likely to recall their physicians recommending screening even though recommendation was documented in the chart (p < .05). Refusers were less likely to have ever had a mammogram (p < .05). This subgroup of patients does not obtain mammograms, finds physician recommendation an insufficient stimulus for mammography, and considers insurance coverage a concern without investigating it.

Aged↗
PubMed1991

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. A surprisingly high percentage were concerned about stress and depression (40 percent) and suicide (11 percent). One-third of students had either planned or attempted suicide, suggesting that appropriate health education for this age group should include more emphasis on psychosocial issues and stress management.

Accidents, Traffic↗
PubMed1991

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. While they were on a steady dose of the OC Ortho-Novum 1/35, serum concentrations of ethinyl estradiol, norethindrone, and endogenous progesterone were measured on days 18, 19, and 20 of the menstrual cycle (control phase). These measurements were repeated on days 18, 19, and 20 of the following menstrual cycle while the patient was taking doxycycline, 100 mg twice daily (treatment phase). No statistically significant differences in serum levels of ethinyl estradiol, norethindrone, or endogenous progesterone were seen between the control and treatment phases. However, there was large inter-patient and intra-patient variability in ethinyl estradiol and norethindrone levels. No elevations of endogenous progesterone occurred to suggest ovulation during antibiotic administration in either phase. It is not known what effects longer or earlier administration of doxycycline during the OC cycle would have on serum hormone concentrations or ovulation. Pregnancies attributed to failure of OCs because of tetracycline use could in fact be due to other causes or could represent a true interaction that only manifests itself in a small proportion of women at risk.

Adult↗
PubMed1983

Routine screening for gestational diabetes mellitus in a family practice center.

In the past women were evaluated for gestational diabetes only if certain historical risk factors were present; recently, the Family Practice Department at West Virginia University began screening all pregnant women. Sixteen of 50 women tested had an abnormal screening test. Of these, 15 had oral glucose tolerance testing, which led to three having a diagnosis of gestational diabetes. The universal screening was found to be more sensitive in finding cases of gestational diabetes, while the average cost per patient for glucose testing was increased by less than $2.

Adult↗