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PubMed1988

A case-control study of testicular cancer using Connecticut tumour registry data.

This case-control study was designed to determine whether males who were exposed to diethylstilboestrol (DES) in utero are at increased risk of testicular cancer. Questionnaires were completed for 79 residents of Connecticut, who were diagnosed with primary cancer of the testes between 1945 and approximately six months into 1980. An equal number of matched controls drawn from birth certificate records available from the Connecticut State Department of Health Services also submitted questionnaires. Information included data on past medical conditions of subjects and obstetrical history of mothers. The major finding of this study was a statistically significant elevated risk for premature birth for the testicular cancer cases. The study failed to show that DES increased the risk for testicular cancer. However, in view of the findings from previous human and animal studies of such abnormalities as undescended and hypoplastic testes as well as the consideration that only the earliest exposed birth cohort has reached the age of substantial cancer risk, it would seem prudent for any male who has been prenatally exposed to DES to seek medical follow-up.

Adult↗
PubMed1997

Are cancers of the salivary gland increasing? Experience from Connecticut, USA.

BACKGROUND: Recent studies indicate that cancers of the salivary gland are increasing, and the factors responsible for the increase are unknown. Artefactual changes, such as shift in classifying cancers of the floor of the mouth to cancers of the salivary gland, could affect the time trend for salivary gland cancer. METHODS: The current study examined the time trends for cancers of the salivary gland and for cancers of the floor of the mouth and lower gum by using Connecticut Tumor Registry data for the time period 1935-1992. A regression model was used to identify the components of birth cohort, period and age as determinants of the observed time trend. RESULTS: Cancers of the salivary gland have recently increased in Connecticut, with a relative risk of 1.48 (95% CI: 1.06-2.08) for females in 1990-1992 compared to 1980-1984, and a comparable relative risk of 1.60 (95% CI: 1.16-2.22) for males. The increase was found in all age groups 40 and over, particularly among those aged 70 and over. The results from age-period-cohort modelling show a recent upturn in the trend for period slopes, with no clear increase from recent birth cohorts, which is consistent with the results from univariate analyses suggesting no clear increase among those under 40 years of age. CONCLUSION: Our results suggest that artifactual changes, such as a shift in designation of cancer sites, increasing use of the needle aspirate biopsies, and greater access to medical care for the elderly, may have largely contributed to the rising trend. The known risk factors, radiation exposure and a history of a prior cancer, can hardly explain the observed increase. The Epstein-Barr virus infection has only been associated with certain types of rare squamous cell carcinomas of the salivary gland in the Eskimo population. The AIDS epidemic also cannot explain why older age groups have accounted for most of the increase in incidence of the disease. An examination of the incidence rates for cancers of the salivary gland from other populations may help to clarify the issue.

Adult↗
PubMed1998

Sunlamp use and the risk of cutaneous malignant melanoma: a population-based case-control study in Connecticut, USA.

BACKGROUND: The relationship between cutaneous malignant melanoma and sunlamp use is examined in a Caucasian population in Connecticut, United States. METHODS: Cases were diagnosed between 15 January 1987 and 15 May 1987 with a first primary cutaneous melanoma. Controls were obtained from the general population, frequency matched to cases by sex and age, through random digit dialling of Connecticut telephone numbers. RESULTS: Of all study subjects, 141 (23%) cases and 95 (19%) controls reported ever having used sunlamps. The crude odds ratio (OR) for developing malignant melanoma after ever having used sunlamps was 1.30 (95% confidence interval [CI]: 0.97-1.74). This was reduced to 1.13 (95% CI: 0.82-1.54) after further adjusting for cutaneous phenotype and recreational sun exposure. Those who used more than one type of sunlamp had a threefold higher risk for melanoma compared to never users. Subgroup analyses showed that sunlamp use was associated with a greater increase in risk for melanoma among those who used sunlamps at home and those who were first exposed to sunlamps prior to 1971. The first use of sunlamps before the age of 25 showed somewhat higher risk for melanoma compared to first use later in life. CONCLUSION: The current study provides limited evidence that use of sunlamps increases the risk of melanoma. For future studies, it is crucial that type of sunlamp, year of first use and amount of exposure are all taken into account. The association between melanoma and tanning with both UV-A and UV-B lamps and tanning under sunlamps early in life merits further investigation.

Case-Control Studies↗
PubMed1995

Prospective assessment of Lyme disease in a school-aged population in Connecticut.

To determine the incidence and cumulative frequency of Lyme disease in a school-aged population in an area in which Lyme disease is endemic, serum specimens were obtained before and after the 1990-1992 tick seasons from 410 middle and high school students in southeastern Connecticut. Sera were tested for serologic evidence of infection with Borrelia burgdorferi, and students were questioned about physician-confirmed episodes of clinical Lyme disease. At enrollment, 29 (7%) students had a history of Lyme disease, and of these, 12 (41%) were seropositive for B. burgdorferi infection. Seronegative students (397) were followed prospectively over a total of 796 person years. At enrollment, 381 students (93%) had no history of Lyme disease, and of these, 1 (0.3%) was seropositive. During this period, 8 students developed clinical Lyme disease and 3 had asymptomatic infections with B. burgdorferi. The incidences of clinical Lyme disease and asymptomatic B. burgdorferi infection were 10.1 and 3.8 cases/1000 person-years, respectively. Lyme disease is an important health problem in school-aged children living in southeastern Connecticut.

Adolescent↗
PubMed1996

Presence of Ixodiphagus hookeri (Hymenoptera: Encyrtidae) in two Connecticut populations of Ixodes scapularis (Acari: Ixodidae).

Two Connecticut populations of the black-legged tick, Ixodes scapularis (Say), the vector of Lyme disease spirochetes, Borrelia bugrdorferi sensu stricto Johnson, Schmid, Hyde, Steigerwalt & Brenner, in the northeastern United States, are parasitized by the encyrtid wasp Ixodiphagus hookeri (Howard), formerly Hunterellus hookeri. The wasp was first detected in ticks from a forested site in Bridgeport in 1992. I. hookeri was reared from 18.6% of 148 host-seeking I. scapularis nymphs. In 1993 and 1994, this wasp was found to parasitize 26.0% of 192 engorged nymphs from Bridgeport and 21.8% of 101 nymphs from the Bluff Point Coastal Preserve in Groton. Each parasitized nymph produced an average of 6-8 wasps (range, 3-16) with a female to male sex ratio of 1.9-1. Both study sites are wooded, geographically isolated tracts (Bridgeport, 176 ha and Bluff Point, 326 ha) with high densities (51-72/km2) of white-tailed deer, Odocoileus virginianus (Zimmerman), and superabundant tick populations similar to that of Prudence Island, RI, where I. hookeri also has been reported. We found that I. hookeri emerged from 16.3% of 399 engorged nymphs and 13.7% of 1,081 engorged nymphs collected as unfed ticks from Prudence Island in 1990 and 1991, respectively. No wasps were obtained from nymphs collected in Stamford (n = 38) or Old Lyme, CT (n = 241). A high proportion (23.1% of 39) of engorged nymphs obtained from Bridgeport deer produced I. hookeri. However, only 2 nymphs (6.7%) recovered from white-footed mice, Peromyscus leucopus (Rafinesque), at Bridgeport were parasitized by the wasp. None of the engorged larvae recovered from deer or mice and fed as nymphs in the laboratory produced I. hookeri (n = 26 from deer and n = 384 from mice). The presence of this wasp in I. scapularis at these 2 insular-like sites on the Connecticut mainland supports the observation that high tick densities are required for the establishment and maintenance of I. hookeri and that the potential role of this wasp in the biological control of I. scapularis is limited.

Animals↗
PubMed2005

Isolations of Potosi virus from mosquitoes (Diptera: Culicidae) collected in Connecticut.

Potosi virus (POTV) (Bunyaviridae: Orthobunyavirus) was first isolated from Aedes albopictus (Skuse) collected in Potosi, MO, in 1989, and subsequent isolations were reported from Illinois, Michigan, Ohio, and the Carolinas. To determine whether the distribution of this virus extends into the northeastern United States, we analyzed arboviruses acquired from mosquitoes collected in Connecticut from 1998 to 2004. In 2001, a bunyavirus was isolated from Aedes vexans (Meigen) that was different from other arboviruses known to occur in Connecticut by cross-neutralization and reverse transcription-polymerase chain reaction (RT-PCR) assays. Nucleotide and encoded amino acid sequences of a portion of the G2 envelope gene were 99 and 100% similar to POTV, respectively, yet distinct from indigenous strains of Jamestown Canyon (JCV), Cache Valley (CVV), and Trivittatus virus (TVTV). Viral isolates obtained from the statewide surveillance program were retested by RT-PCR coupled with restriction enzyme analysis to distinguish POTV from other bunyaviruses. POTV isolates, previously typed by neutralization, were correctly identified by RT-PCR; however, many isolates classified as JCV or CVV by enzyme-linked immunosorbent assay proved to be POTV by molecular assays. In total, 92 strains of POTV were isolated from 12 mosquito species in 2000, 2001, and 2003, whereas POTV was not detected in mosquitoes sampled during 1998, 1999, 2002, and 2004. Viral isolation rates were highest for Anopheles punctipennis (Say) (3.2-11.3 infection rate per 1,000 mosquitoes), whereas the greatest number of isolates came from Ochlerotatus trivittatus (Coquillett) (8-16 isolates). This finding represents the first detection of POTV in the northeastern United States where it infects a diverse array of mosquito species.

Animals↗
PubMed1999

Postmastectomy breast reconstruction in Connecticut: trends and predictors.

Using the population-based Connecticut Tumor Registry, postmastectomy breast reconstruction was examined in the 10,756 breast cancers in Connecticut women (including 10,133 in white women and 554 in black women) diagnosed from 1988 to 1995. Reconstruction increased from 6.4 percent of cancers in 1988 to 9.1 percent in 1991, but it declined to 4.7 percent of cancers in 1992 (when the Food and Drug Administration instituted a restriction on the use of silicone gel implants); by 1995, the rate had recovered to 8.5 percent. Reconstruction was negatively associated with age, poverty rate of the census tract of residence, and black (versus white) race; these associations require further study.

Adult↗
PubMedDate not supplied

The syphilis epidemic in Connecticut: relationship to drug use and prostitution.

Syphilis rates in Connecticut increased four-fold between 1986 and 1988. During this time there were also signs of a large increase in cocaine use in the state. We studied links between these parallel trends in drug use and syphilis by examining two sources of data: information collected during syphilis case interviews and information from the syphilis screening program at the state's prison for women. As syphilis rates rose, there were large increases in the percentage of women with syphilis who reported prostitution or illicit drug use. In 1988, 41% of women with syphilis reported cocaine use, and 19% reported prostitution; 21% of male heterosexuals with syphilis reported cocaine use, and 31% reported sexual contact with prostitutes. Among incarcerated women, syphilis infection was frequent: of 113 women incarcerated for possession of illicit drugs in 1987-88, 7% were found to be infected with Treponema pallidum, and of 187 women incarcerated for prostitution in these years, 14% were infected. In both groups of incarcerated women studied, cocaine users had the highest syphilis rates, and those who administered drugs nonintravenously had rates similar to those who administered drugs intravenously. We concluded that the syphilis epidemic in Connecticut is related to the increase in use of illicit drugs (primarily cocaine) and that female drug users are at very high risk of syphilis regardless of whether they administer drugs intravenously or nonintravenously. We recommend that syphilis control efforts focus on wider serologic screening and early treatment of drug users, prostitutes, and their sex partners.

Connecticut↗
PubMed1996

Underreporting of Lyme disease by Connecticut physicians, 1992.

To determine the magnitude of underreporting of Lyme disease, a random sample of Connecticut physicians was surveyed in 1993. The magnitude of underreporting was assessed by comparing physician estimates of Lyme disease diagnoses with reports of Lyme disease sent by physicians to the Connecticut Lyme disease surveillance system. Complete questionnaires were returned by 59 percent (412/698) of those surveyed. Of the 224 respondents who indicated that they had made a diagnosis of Lyme disease in 1992, only 56 (25 percent) reported a case of Lyme disease that year. Survey results suggested that, at best, only 16 percent of Lyme disease cases were reported in 1992. Physician underreporting of Lyme disease underestimates the public health impact of Lyme disease.

Connecticut↗
PubMed1997

Trends in infant mortality in Connecticut, 1981-1992.

Assessing infant mortality rates (IMRs) is important in public health planning. However, single year fluctuations in IMRs often receive attention without consideration of long-term trends. Trends in IMR over 12 years in Connecticut were examined using linked birth and death files. Overall, there was an exponential decline in IMR from 12.2/1,000 live births in 1981 to 7.3/1,000 live births in 1992. However, differential declines in IMRs resulted in an increased relative risk of infant death over time for infants of Black women compared with infants of White women. IMRs were also higher for infants of Black, teenaged, and less educated mothers. Targeted local maternal and child health programs are needed if IMRs are to continue to decline for all sections of the population in Connecticut.

Age Factors↗
PubMed2003

Shade tobacco and green tobacco sickness in Connecticut.

The prevalence of Green Tobacco Sickness (GTS) among shade tobacco farmworkers in Connecticut is unknown. We conducted a study to determine the prevalence of GTS in farmworkers working in shade tobacco fields who presented for clinical care at medical student-run clinics. A retrospective chart review of the tobacco workers seen at Farmworkers' Clinics during 2001 was instituted in this study. Although GTS was not clinically diagnosed in any of the patients, we found 15% diagnoses that could be attributed to possible GTS by ICD-9 code review. Using a stricter GTS case definition, the frequency rate decreased to 4%. Nonsmokers were significantly more likely than smokers to report GTS-like symptoms (P < 0.01). Isolated symptoms of headache and dizziness were significantly more frequent among nonsmokers than smokers (P < 0.05). In conclusion, cases of possible GTS were found in Connecticut shade tobacco workers. Nonsmokers were more at risk to have possible GTS than smokers.

Adolescent↗
PubMed2002

The Connecticut Mental Health Center Patient Profile Project: application of a service needs index.

This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a statefunded agency that provides comprehensive clinical and rehabilitative services to persons with mental illness. Also described is how this information guided management decisions in both caseload distribution and clinical service development. This "Patient Profile Project" was informed by research principles which view evaluation as continual, rather than terminal activity that involves key stakeholders from all levels within the mental health system of care and makes maximum use of data in ongoing performance improvement initiatives. The service-need index that the project produced represents our first efforts to accurately capture service need and use it in clinical decision making. This review of the Connecticut Mental Health Center Patient Profile Project illustrates the utility of a continuous evaluation system in promoting improvements in a large mental health treatment system.

Adult↗
PubMed1992

Public-private partnerships: the Connecticut model for financing long-term care.

Responses to the growing crisis in long-term care financing have included efforts to negotiate partnerships between the private and public sectors for the purpose of developing innovative models for long-term care insurance. One such set of models has been encouraged by support from the Robert Wood Johnson Foundation's "Long Term Care Insurance Program" grants. The Connecticut Partnership for Long Term Care uses a cooperative approach to encourage the development of private sector long-term care insurance products that are integrated with Medicaid eligibility determinations. The Connecticut model is described, accompanied by a history of its development, and a comparison is made with other models currently under consideration by national policy analysts.

Connecticut↗
PubMed2005

Demonstrable parasitemia among Connecticut blood donors with antibodies to Babesia microti.

BACKGROUND: Reports of transfusion-transmitted Babesia microti have risen steadily during the past several years, reflecting a concurrent increase in US cases of human babesiosis. Although several studies have measured B. microti antibodies in blood donors, little is known about associated parasitemia and the inherent risk of transmitting the parasite by transfusion. STUDY DESIGN AND METHODS: Donations from blood donors located in Babesia-endemic and nonendemic areas of Connecticut were tested for B. microti antibodies from July through September. Subsequently, an additional blood sample was collected from selected seropositive donors and tested by nested polymerase chain reaction (PCR) for B. microti nucleic acids. RESULTS: A total of 3490 donations, 1745 each from endemic and nonendemic areas, were tested for B. microti antibodies; 30 (0.9%) were confirmed as positive and seroprevalence rates peaked in July. Significantly more seropositive donations were from endemic areas (24, 1.4%) than nonendemic areas (6, 0.3%). Ten (53%) of 19 seropositive donors subsequently tested by PCR were positive. CONCLUSION: B. microti seroprevalence was highest in those areas of Connecticut where the parasite is endemic. More than half of seropositive donors tested had demonstrable parasitemia, indicating that many are at risk for transmitting B. microti by blood transfusion. Three donors were identified as parasitemic in October, suggesting that donors may be at risk for transmitting the parasite outside of the peak period of community-acquired infection.

Antibodies, Protozoan↗
PubMed1999

Isolation of West Nile virus from mosquitoes, crows, and a Cooper's hawk in Connecticut.

West Nile (WN) virus, a mosquito-transmitted virus native to Africa, Asia, and Europe, was isolated from two species of mosquitoes, Culex pipiens and Aedes vexans, and from brain tissues of 28 American crows, Corvus brachyrhynchos, and one Cooper's hawk, Accipiter cooperii, in Connecticut. A portion of the genome of virus isolates from four different hosts was sequenced and analyzed by comparative phylogenetic analysis. Our isolates from Connecticut were similar to one another and most closely related to two WN isolates from Romania (2.8 and 3.6 percent difference). If established in North America, WN virus will likely have severe effects on human health and on the health of populations of birds.

Aedes↗
PubMedDate not supplied

Interpretation of secular increases in incidence rates for primary brain cancer in Connecticut adults, 1965-1988.

Available summaries of radiology reports were examined among 899 primary brain cancer cases (age 40 years and older) diagnosed in Connecticut residents in selected years from 1965 to 1988 and reported to the population-based Connecticut Tumor Registry. Adjustment for the lower sensitivities of radiologic tests used before the advent of computerized tomography (CT) suggested that the introduction of CT (by itself) could account for little of the secular increase in brain cancer rates. Examination of trends in age-standardized rates for histologically confirmed brain cancers in the elderly, after excluding those diagnosed only by radiologic tests, did not support the idea that the secular trend in the elderly was largely artifactual.

Adolescent↗
PubMed2000

Later-stage cancer in relation to medically underserved areas in Connecticut.

Health status indicators, including advanced stage at diagnosis of cancer, have been proposed as indicators of health care access and quality to be considered in revising the definition of medically underserved areas (MUAs). Using the population-based Connecticut Tumor Registry, "outlier" census tracts were defined as those that had a high proportion of breast, colorectal, or cervical cancer diagnosed at later stage, relative to all tracts in the state. In the six Connecticut cities that had MUAs, MUAs comprised the majority of outlier tracts, but non-MUA outliers were often located on the fringes of MUAs. The findings are discussed in relation to revising the criteria for defining MUAs and to targeting interventions for early detection of cancer in urban areas.

Aged↗