Evaluation of a workplace hemochromatosis screening program

Hemochromatosis is a common inherited disorder of iron metabolism with significant health consequences for the employed population. Although screening for hemochromatosis has been recommended, workplace screening programs remain uncommon. In the first year of a newly initiated corporate screening program, 1968 employees were tested. The screening algorithm included measurement of serum iron and transferrin and subsequent ferritin levels in those employees with elevated iron/transferrin ratios. Thirteen percent of men and 21% of women had elevated iron/transferrin ratios. Of these, 14 men and 2 women had elevated ferritin levels. Of these 16, three had liver biopsies and all three have hemochromatosis. The cost of the screening program was $27,850. The cost per diagnosis was $9283 and the cost per year of life saved was $928. These costs compare very favorably with other common workplace screening programs. Several barriers to obtaining definitive diagnoses on all patients with a positive screening result were identified; strategies to overcome these barriers would further enhance the cost effectiveness of the program. We conclude that workplace hemochromatosis screening is highly cost effective and should be incorporated into health promotion/disease prevention programs.     

Self-reported legal needs of women with or at risk for HIV infection

Women at risk for human immunodeficiency virus (HIV) infection are often poor and members of racial or ethnic minorities. In addition to legal concerns that might be common among persons with similar sociodemographic characteristics, HIV infection adds the potential of possible stigma and discrimination, as well as the prospect of illness and increased mortality. To determine women's perceptions of need for and access to legal services and whether such perceptions are affected by HIV infection, from November 1993 through September 1995 we interviewed 509 women with or at risk for HIV infection by virtue of injection drug use or high-risk sexual behaviors in New York and Baltimore, Maryland. A majority of women, regardless of HIV serostatus, reported current or future needs for legal assistance with government benefits. More than 25% reported needing current or future legal help with housing, debts, arrangements for care of children, a will, and advance directives. Substantial minorities of women reported other legal needs. HIV-positive women were significantly more likely to report anticipated future need for help with paternal custody or visitation, current need in making a will, and anticipated future assistance with advance directives. For most items, a majority of women thought they knew where to receive help. However, among women reporting a current need, only a minority actually were receiving legal assistance. This study suggests that the extent of legal needs among women with or at risk for HIV infection is substantial, and that few receive legal assistance. With few exceptions, at least for women early in the course of illness, HIV infection does not appear to alter the pattern or extent of legal needs. There are dramatic differences, regardless of HIV status, between expectation and reality in women's access to legal services. Members of the HER Study group are listed in the Appendix. Supported by cooperative agreements U64/CCU206798 and U64/CCU306802 with the Centers for Disease Control and Prevention. During the study, Paula DiStabile was supported by the Skadden Fellowship Foundation and sponsored by New York Lawyers for the Public Interest, New York, New York. Presented, in part, at the HIV Infection in Women Conference, February 22–24, 1995, Washington, DC.     

Treatment of Synchronous Mucinous Carcinoma and Endocrine Mucin–Producing Sweat Gland Carcinoma with Mohs'' Micrographic Surgery

BACKGROUND: Endocrine mucin-producing sweat gland carcinoma is a very rare cutaneous tumor that has been reported only in three patients previously. We report a case of an endocrine mucin-producing sweat gland carcinoma associated with mucinous carcinoma treated by Mohs' micrographic surgery. OBJECTIVE: The purpose of this report is to test the utility of Mohs' micrographic surgery in the treatment of mucinous carcinomata. METHODS: A 79-year-old female with a 2-year history of four lesions of biopsy-proven endocrine mucin-producing sweat gland carcinomas and mucinous carcinoma was treated with Mohs' micrographic surgery. RESULTS: Three of the lesions were completely cleared by Mohs' micrographic surgery. The fourth lesion, in the right lateral canthus, was not cleared by the Mohs' technique because of its location within the orbit and the difficulty of retraction of the globe for appropriate visualization and excision. The patient underwent wide excision of the remaining orbital tumor and reconstruction, which was successfully accomplished. The patient did not experience a recurrence in any of her four lesions over a 2-year follow-up period. CONCLUSION: Mohs' micrographic surgery is an appropriate treatment for mucinous carcinomata, including endocrine mucin-producing sweat gland carcinoma and mucinous carcinoma.