Ulithi Atoll health assessment: a peek at the health of rural Micronesia.

BACKGROUND: The health challenges of Micronesians are generally well known. However most of the health-related data collection occurs in the population centers and relatively little is known about the health of the residents of Micronesia's rural outer islands. This is of particular concern in the Federated States of Micronesia (FSM) where a large portion of the population lives on the outer islands. To gain a better understanding of the health issues facing the isolated outer islands of Micronesia, a health survey was performed on Ulithi Atoll in Yap, FSM. METHODS: A survey was created by the Yap State Department of Health Services and members of the Ulithian community. The survey was carried out on two of the four inhabited islands of Ulithi Atoll in July 2004. Both island communities actively participated in the survey providing translation and data gathering assistance. RESULTS: It was estimated that a >90% response rate for both islands was achieved. Analysis demonstrated that relative to the U.S., the Atoll's population experienced high rates of obesity (45%), hypertension (29%), and smoking (55%). Sixty-six percent of men surveyed reported alcohol use versus 16% of women. Use of alcohol was markedly lower on Fatharai Island where a Chief had mandated abstinence. Preventative health screening was limited with over 80% of women having pap smear in the past 2 years. In addition, the community identified finances and transportation as the main difficulties in accessing healthcare. CONCLUSION: Overall, the research identified a number of health issues that require closer attention, in particular hypertension, overweight, obesity, alcohol misuse, smoking prevalence, betel nut/ tobacco chewing, and domestic violence. There is indication that the community may be ready to address some of these issues. The value of community action within cultural frameworks is apparent, and there may be potential to extend culturally-based approaches to address a broader range of issues.

T-cell lymphopenia associated with infliximab and cyclophosphamide.

We report the first case of T-cell lymphopenia in a woman with rheumatoid arthritis who developed molluscum contagiosum with infliximab and cyclophosphamide. She presented in July 2000 with optic neuropathy and arthritis refractory to nonsteroidal anti-inflammatory drugs. After starting prednisone and cyclophosphamide, she became leukopenic (1.8x10 cells/microL), a condition that resolved with decreasing of the cyclophosphamide dose. In June 2002, the patient continued to have synovitis despite treatment with prednisone, cyclophosphamide, gabapentin, and celecoxib; blood counts were normal and infliximab was started. Her symptoms improved, but leukocyte counts declined (nadir of 1.5x10 cells/microL) despite discontinuing cyclophosphamide. She developed molluscum contagiosum after 8 months on infliximab (CD4 count, 492; HIV enzyme-linked immunosorbent assay and Western blot negative). Her symptoms flared after 10 months on infliximab; after the dose of infliximab was increased, her CD4 count fell to 114. Infliximab was discontinued and her leukocyte and CD4 count increased. This is the first reported case of leukopenia and T-cell suppression associated with infliximab and cyclophosphamide.

Effect of delivery route on natural history of cervical dysplasia.

OBJECTIVE: This study was undertaken to determine the (1) impact of delivery route on the natural history of cervical dysplasia and (2) overall regression rates of cervical dysplasia in pregnant women. STUDY DESIGN: A retrospective analysis was performed on 705 pregnant women with abnormal Papanicolaou tests who presented for prenatal care at the Kapiolani Medical Center Women's Clinic in Honolulu, Hawaii, between 1991 and 2001. Data collection included demographics, delivery route, and cervical pathology. RESULTS: Two hundred one patients met the inclusion criteria. Regression rates for vaginal and cesarean section groups were as follows: atypical squamous cells (64% vs 70%, P = .32), low-grade squamous intraepithelial lesion (58% vs 42%, P = .073), and high-grade squamous intraepithelial lesion (53% vs 25%, P = .44). Of the total population, 30% of lesions persisted postpartum, 58% regressed, and 12% progressed. CONCLUSION: Mode of delivery does not influence the natural history of dysplastic lesions. Gravid and nongravid women have similar regression rates.