Helping Wisconsin women quit smoking: a successful collaboration.

The cost of treatments for tobacco dependence frequently presents a financial barrier to their use. To overcome such barriers, the Wisconsin Women's Health Foundation, the Wisconsin Bureau of Public Health, the McNeil Consumer Healthcare, and the University of Wisconsin Center for Tobacco Research and Intervention collaborated in an initiative to distribute nicotine patches to Wisconsin women at no cost. As a result of this collaborative effort, approximately 19,000 women received a 6-week course of Nicotrol Patches. To evaluate the effectiveness of this initiative, a sample of 500 recipients were contacted and surveyed by telephone 6 months after receiving their patches. Approximately 22% of these women reported total abstinence at 6 months, and another 77% reported they had reduced their smoking. At follow-up, women who had successfully quit rated their health status significantly better than women who were still smoking. More than 99% of respondents recommended that the program be repeated. Extrapolating the observed abstinence rate to the 19,000 patch recipients, an estimated 4000 Wisconsin women successfully quit smoking as a result of this program.

Imported seabass as a source of mercury exposure: a Wisconsin case study.

The Wisconsin Division of Health investigated mercury exposure in a 40-year-old man, his 42-year-old wife, and their 2.5-year-old son. At the time of our investigation, these individuals had blood mercury levels ranging from 37 to 58 micrograms/L (normal < 5 micrograms/L) and hair samples from the adults contained 10-12 micrograms mercury/g dry weight. A personal interview and home inspection failed to identify any occupational or household sources of mercury exposure. The family's diet included three to four fish meals per week. The fish was purchased from a local market and included Lake Superior whitefish, Lake Superior trout, farm-raised trout and salmon, and imported seabass. Analysis of these fish found that only one species, the imported seabass, contained significant mercury levels. Two samples of the seabass obtained from the vendor on different days contained mercury concentrations of 0.5 and 0.7 mg/kg. Based on consumption estimates, the average daily mercury intakes for these individuals ranged from 0.5 to 0.8 micrograms/kg body weight. Six months after the family stopped consuming the seabass, blood mercury levels in this man and woman were 5 and 3 micrograms/L, respectively. Analysis of sequential blood samples confirmed that mercury elimination followed first-order kinetics with a half-life of approximately 60 days.

Gastrointestinal upsets associated with ingestion of copper-contaminated water.

During 1992 and 1993 the Wisconsin Division of Health investigated five cases in which copper-contaminated drinking water was suspected of causing gastrointestinal upsets. Each of these case studies was conducted after our office was notified of high copper levels in drinking water or notified of unexplained illnesses. Our findings suggest that drinking water that contains copper at levels above the federal action limit of 1.3 mg/l may be a relatively common cause of diarrhea, abdominal cramps, and nausea. These symptoms occurred most frequently in infants and young children and among resident of newly constructed or renovated homes.

Seroresponse to hepatitis B vaccine in patients and staff of renal dialysis centers, Wisconsin.

Since June 1982, the Wisconsin Chronic Renal Disease Program has provided reimbursement for hepatitis B virus vaccine and pre- and postvaccine serologic testing for patients and staff in all Wisconsin renal dialysis centers. Between July 1, 1982 and June 30, 1984, 444 dialysis patients in 22 renal dialysis centers and 128 staff from nine renal dialysis centers each received three doses of hepatitis B virus vaccine and were tested more than 14 days after the third dose. Antibody response (antibody to hepatitis B surface antigen) occurred in 208 (47%) patients and was age-dependent; the rate of antibody response ranged from 86% (for those aged less than 30 years) to 32% (for those aged over 70 years). Among staff, the rate of antibody response ranged from 96% (for those aged less than 35 years) to 71% (for those aged over 45 years). Results of a multiple logistic regression analysis showed that within age groups, antibody response in dialysis patients was positively associated with length of time on dialysis prior to receipt of vaccine (p = 0.014) and negatively associated with the time interval between the third dose and postvaccine testing (p = 0.0003). Variables that did not enter the regression equation were dialysis mode and frequency, transplant status, concurrent medication use, and injection site. Given the low rates of post-hepatitis B virus vaccine antibody response observed in renal dialysis center patients reported here, the authors recommend that hepatitis B virus vaccine plus alternative hepatitis B virus preventive methods be used. Consideration should be given to a schedule for testing of all vaccinated patients and staff aged over 40 years to ascertain postvaccine susceptibility to hepatitis B virus infection.