Structural infestations by imported fire ants: a survey with health implications.

This study provides the first baseline estimate of the impact of indoor IFA infestations in all 46 counties of our state. Clinicians need to be alert to the threat of unprovoked stings and possible anaphylaxis among disabled or confined patients in a variety of indoor settings.

Medical students' abilities to take an occupational history: use of the WHACS mnemonic.

This study examined medical students' use of the WHACS mnemonic during an occupational history objective structured clinical examination station. Students' performance on the 10 content-specific station items was calculated. Factor analysis of the items was conducted, and student demographic and academic characteristics associated with performance on the station were examined. A total of 205 students completed the station. The mean number of correct responses was 5 (SD, 1.6). Students performed well on some items and less well on others. Factor analysis supported the WHACS framework. There were no significant associations with student demographic or academic characteristics. Students were aware of the particular features of an occupational history but were deficient in other areas; this awareness was not related to demographic or academic characteristics. The WHACS mnemonic could be an effective tool to teach occupational history-taking skills.

Fire ants: a continuing community health threat in South Carolina.

Imported fire ants are now firmly established in all 46 counties of South Carolina. In 1998 there were an estimated 660,000 cases in the state of which approximately 33,000 sought medical treatment at an estimated cost of 2.4 million dollars. Residents and visitors are at risk for IFA attacks that may occur indoors as well as outdoors. While IFA sting victims in endemic areas of the state may be less likely to seek medical treatment, patients in recently infested areas seem to be more likely to seek treatment since they are relatively unfamiliar with the multiple, painful IFA stings and pustules. Citizens need to control IFA infestations around and within their homes according to guidelines recommended by the Clemson University Cooperative Extension Service. Regional IFA control programs were discontinued in the past because of costs and environmental chemical concerns. Obviously, we need to support ongoing research aimed at developing improved and safe strategies for the local and regional control of IFA.

The occupational and environmental medicine gap in the family medicine curriculum: needs assessment in South Carolina. Part I.

The occupational and environmental medicine (OEM) gap in US medical education is widely recognized. In 1992, a federal initiative stimulated a primary care approach to improve residency training in South Carolina. This three-part report documents progress in designing and implementing an OEM curriculum, which is family medicine-centered. Each of the state's residency training programs participate in an ongoing Environmental Medicine Curriculum Committee effort. Part 1, discusses the needs assessment; Part 2, the five key elements of curriculum; and Part 3 details a clinical guide to the OEM patient.

The occupational and environmental medicine gap in the family medicine curriculum: five key elements in South Carolina. Part II.

Part II of our three-part report examines five of the key elements for occupational and environmental medicine (OEM) training in family medicine residency. These were introduced by the Environmental Medicine Curriculum Committee (EMCC) faculty in South Carolina under a Department of Energy (DOE) grant to the Environmental Hazards Assessment Program (EHAP) of the Medical University of South Carolina, 1992-1997. Each element is being designed, tested, and updated by clinicians in the residency network. A pilot study of 100 third-year medical students conducted in 1996 suggests the difficulty in implementing OEM skills in current family medicine training.

A clinical guide to the occupational and environmental medicine patient in a busy family practice: the two-task, four-prototype approach in the SC/EHAP initiative. Part III.

A four-prototype approach to the occupational and environmental medicine (OEM) patient in a busy primary care setting is described. A 2 x 2 table illustrates the two diagnostic, interrelated tasks during the outpatient, non-urgent visit: (a) sick? yes/no, and (b) exposed? yes/no. One may have the basic skills for task (a) but feel insecure for task (b). With OEM experience, creative use of resources (databases and consultants), and patient cooperation, a better balance between task (a) and task (b) can be achieved. The Environmental Medicine Curriculum Committee (EMCC) initiative described in Part I and Part II of this study has developed this patient-centered model to help the resident in training cope as he or she tries to deal with emerging patient concerns from the workplace and beyond. In November 1996, an expert panel of consultants representing OEM, public health, and family medicine endorsed the prototype OEM patient model for further development.

1990 South Carolina Physician Survey of tick, spider and fire ant morbidity.

A population of 2,366 primary care physicians in South Carolina was surveyed by mail to estimate the number of cases of insect morbidity treated in 1990. A response rate of 42.3 percent was obtained. Cases reported totaled 414 for Rocky Mountain spotted fever, 334 for Lyme disease, 143 black widow and 478 brown recluse spider bites and 4,975 fire ant stings. These are counts of cases from a mail survey, not from a research-based study. Five deaths were also reported; two for Rocky Mountain spotted fever, two due to black widow spider bites and one fire ant anaphylaxis.

Near death of a woman stung by red imported fire ants: management of anaphylaxis.

Patients with allergic reactions to RIFA should be instructed in avoidance of RIFA and in the administration of epinephrine, given emergency identification information, and referred to an allergist for definitive diagnosis and for desensitization as indicated. RIFA are a growing menace in this country; as their habitat steadily extends north and west, no doubt a growing number of people will be affected by them. Their sting can be acutely life threatening and, as in this one case example, a severe reaction can profoundly affect the life of the victim.

Practice-based agromedicine: the need for client-centered research.

During recent years, several client calls received from Clemson University Cooperative Extension Service office and private physicians have required client-oriented investigations. These have practical implications for preventive medicine and public service. The challenges for differential diagnosis across disciplines are not for the faint-of-heart or the narrow thinking specialist. Examples of incidents that have signaled a problem and resulting research projects are: 1) anaphylactic cardiovascular response to red imported fire ant venom (statewide morbidity survey); (2) unexplained contact dermatitis in tomato harvesters and floral designers (immunodermatologic study and statewide survey of florists); (3) concerns over two unexplained cancer deaths at an experimental agricultural research station (farmer's mortality study); (4) a household outbreak of organophosphate poisoning (statewide hospital morbidity survey); and (5) a woman in early pregnancy exposed to misapplication of chlordane in her house (literature review and update on trends in U.S. birth defects). These examples reflect a broad but responsive interdisciplinary approach to the needs of the clients of the South Carolina Agromedicine Program.

Lyme and other tick-borne diseases acquired in South Carolina in 1988: a survey of 1,331 physicians.

2,346 primary care physicians were surveyed by mail to estimate the number of cases of tick-borne fever diagnosed by them during 1988. The results of the 57% response reveal 344 cases of Rocky Mountain Spotted Fever, 90 cases of Lyme disease and 33 other tick-borne disease cases acquired in South Carolina. The implications for a greater level of clinical awareness and a search for endemic vectors and animal hosts are emphasized.

Update on hospitalized pesticide poisonings in South Carolina, 1983-1987.

Three hundred twelve hospitalizations for pesticide poisoning occurred in South Carolina during 1983-1987. This represents a twenty percent decline from an average of 78.5 cases hospitalized per year (1979-1982) to 62.4 cases hospitalized per year currently. Non-occupational poisonings accounted for one-half of the hospitalizations while 20% were related to occupation. Intentional poisonings represented 27% of the total. Two deaths as a result of suicide occurred during the four year period giving a case fatality of less than 1.0%. This five year update reenforces the need for continued education and prevention efforts.

Environmental factors and high risk of esophageal cancer among men in coastal South Carolina.

A case-control study involving interviews of 207 men with esophageal cancer and 422 control subjects or their next of kin was conducted to identify reasons for the unusually high rates of esophageal cancer among men in coastal South Carolina. Tobacco and alcohol, including moonshine, were identified as the major determinants of esophageal cancer risk. Increased risk was also associated with low intake of fresh fruits but not with drinking of local herbal teas. The findings suggest that efforts aimed at reducing tobacco and alcohol use will help to lower the elevated rates of esophageal cancer in coastal South Carolina.

Agricultural life-style: a mortality study among male farmers in South Carolina, 1983-1984.

After reviewing the death certificates of 2,820 South Carolina agricultural workers (including farmers, farm workers, and others in the agricultural industry) aged 35 to 84 during 1983-1984, we calculated proportional mortality ratios (PMRs). Among both white and nonwhite farmers in South Carolina, the PMR was significantly higher for cerebrovascular disease (whites, PMR = 1.20, P less than .05; nonwhites, PMR = 1.43, P less than .001) and lower for all malignant neoplasms (whites, PMR = 0.86, P less than .05; nonwhites, PMR = 0.78, P less than .001). In addition, external causes of death were elevated, attaining statistical significance for white farmers (PMR = 1.51, P less than .001). Significantly lower PMRs for all malignant neoplasms are attributed to fewer deaths from cancers related to smoking (buccal cavity and pharynx, esophagus, lung, and bladder) and colon and rectal cancers among both white and nonwhite farmers. White farmers did not show significantly elevated PMRs for cancers of the lymphatic and hematopoietic systems found in other studies in the Midwest. These data suggest that agricultural life-style can be improved for the prevention of strokes and for external causes of death.