Key challenges and concepts in health risk communication: perspectives of agency practitioners.

The public demands that federal agencies provide information that is responsive to their fears and explains health risks clearly. In 1998 the Health Risk Communication Coordination Committee of the Agency for Toxic Substances and Disease Registry, a federal public health agency, conducted three focus groups with agency staff to identify current knowledge and understanding of health risk communication (HRC); HRC issues, problems, and best practices; and most appropriate HRC training content. The results indicate a need for clearer communications with communities, greater sensitivity to community concerns and fears, more balanced media coverage, and more accuracy in reporting, among other findings.

Private sector health care organizations and essential public health services: potential effects on the practice of local public health.

This article focuses on the activities of eight private health care organizations undertaking public health and prevention activities. Few activities were motivated by or integrated into the business or operating strategy of the organizations and poor integration with the business strategy puts the long-term future of these activities in jeopardy. The lack of integrated activity can be attributed to: slow pace of managed care implementation; low penetrance of full-risk capitated reimbursement; and fragmented, competitive health care markets. Purchaser pressure, quality assurance requirements, community benefit standards, and government mandates are among the levers available to encourage such activities by the private sector.

Extragenital syphilitic chancres.

Two patients with extragenital chancres are presented to emphasize unusual expressions of primary syphilis. The clinical presentations and differential diagnosis of extragenital chancres are discussed.

Disuse contractures in a patient with tinea manuum and irritant contact dermatitis.

Disuse contractures are reported in a patient with tinea manuum and irritant contact dermatitis. The case is presented to alert the physician to the potential for this problem in any patient with a chronic fissured dermatosis of the hands.

Evaluation of the limulus amebocyte lysate assay for presumptive diagnosis of gonorrhea in men at a clinic for sexually transmitted diseases.

Specimens of urethral exudate from 200 men with uncomplicated urethritis were tested for Neisseria gonorrhoeae by the limulus amebocyte lysate assay, culture on modified Thayer-Martin medium, and gram-stained smear. As compared with cultures, the sensitivity and specificity of the limulus assay were 94.8% and 89.3%, respectively, while the sensitivity and specificity of the gram stain were 98.8% and 100.0%, respectively. The accuracy of prediction of the presence of N. gonorrhoeae was significantly better by gram-stained smear than by the limulus assay. Unless the limulus assay is modified, as it was in this study, it does not appear to have a role in the presumptive diagnosis of the gonorrhea in men at a clinic for sexually transmitted diseases.

Pseudomonas chromonychia.

The patient reported on herein presented with a greenish black great toenail. The discoloration was due to Pseudomonas aeruginosa. This report should alert the practitioner to the fact that Pseudomonas chromonychia may occasionally be mistaken for color changes produced by subungual hematomas, nevi, or malignant melanomas.

Becker's melanosis: an organoid hamartoma.

Herein we have reported the histologic findings in two cases of Becker's melanosis. In one patient the lesion showed hyperplasia or hair muscles and in the other patient the lesion was associated with an underlying neurofibroma. The proliferative changes seen in the epidermis and dermis in Becker's melanosis can best be explained by the concept of an organoid hamartoma with involvement of the epidermis, pilar structures, and some other dermal components. The localization of the plexiform neurofibroma within the Becker's nervus is a unique observation. It may fall within the spectrum of an organoid hamartoma or it may only represent a chance occurrence.

Histologic findings in mummified skin.

Skin specimens from five mummies were examined histologically. The specimens ranged in age from 2,000 to 3,200 years. Material from two mummies had carbonized and showed only amorphous debris. The histology of the three remaining skin fragments retained surprising histologic architectural detail. One specimen obtained from the sole of the foot was compatible with a callus.

Enzymatic detection of Neisseria gonorrhoeae.

In a study using a non-serological enzymatic approach for the detection of Neisseria gonorrhoeae in cervical and urethral swabs, the technique was shown to be technically feasible. The enzyme, 1, 2-propanediol oxidoreductase, was used as a presumptive diagnostic marker for N gonorrhoeae. Enzymatic activity was measured with a fluorometer. Two assay procedures were performed: (a) enzyme detection (two-tube and three-tube assays) requiring 60 minutes; and (b) enzyme inhibition (EI) (90-minute and modified 20-minute assays). Sensitivities of the two-tube, three-tube, and the 90-minute EI assays with male urethral specimens from a high-prevalence population were 80%, 84%, and 91% respectively. The specificities of these assays in a low-prevalence male population were not determined. Sensitivity of the 90-minute EI assay in a high-prevalence female group was 77% and specificity in a low-prevalence female group was 75%. The modified EI assay was tested only in a low-prevalence female group and had 87% specificity. Although the specificity of the assays needs improvement, several advantages--including early case detection, rapid availability of results, detection of current active infections, and the possibility of automation--are intrinsic in this enzymatic approach.

The signs and symptoms of secondary syphilis.

The signs and symptoms of 105 patients with secondary syphilis were evaluated in a clinic for treatment of sexually transmissible diseases. The symptoms were, in order of decreasing frequency, pruritus, 44 patients; sore throat, 16; headache, nine; muscle aches, nine; fever, five; meningismus, three; loss of scalp hair, three; loss of appetite, two; loss of weight, two; and visual disturbances, one. The dominant morphologic characteristics of the lesions, in order of decreasing frequency, were maculopapular, 73 patients; papular, 13; macular, 10; annular papular, six; papulopustular, two; and psoriasiform papular, one. Almost a fourth of the patients were not aware that they had mucocutaneous lesions, and > 20% of patients had inconspicuous lesions. The distributions and morphologic features of the lesions of eight patients (7.6%) suggested other dermatoses.

Psoriasis with tinea corporis.

The case report presented herein documents the unusual simulaneous occurrence of psoriasis and tinea corporis in a patient and reviews the diagnostic and therapeutic problems that arose during the treatment of these two morphologically similar papulosquamous diseases. The report emphasizes the need for careful re-evaluation of patients who have atypical response to therapy.

Genital bowenoid papulosis--squamous cell carcinoma in situ.

The case of a patient with bowenoid papulosis of the penis is described. Although his lesions resembled those of condylomata acuminata, a biopsy showed squamous cell carcinoma in situ. This case and those described in previously published reports confirm that squamous cell carcinoma in situ may exist in a papillomatous form on the genitalia of young adults. Venereologists must be familiar with this entity and must not dismiss all verrucous and papillomatous genital growths as condylomata acuminata.