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At least 199 records · Page 11Linked to original sources
PubMed1997

Urban and rural traumatic brain injuries in Colorado.

PURPOSE: The purpose of this study was to compare and contrast the epidemiology of traumatic brain injury among urban and rural residents of Colorado. METHODS: Cases of traumatic brain injury (ICD 800, 801, 803, 804, 850-854) for 1991 and 1992 from the Colorado surveillance system of hospitalized and fatal traumatic brain injuries were used. Urban cases resided in counties designated by the U.S. Census Bureau as metropolitan statistical areas (MSA). Rural cases were divided into two groups: "rural, nonremote," if the country of residence was adjacent to an MSA county or if it had a population of 2500, and "rural, remote," if not. RESULTS: Average annual age-adjusted rates of hospitalized and fatal traumatic brain injury varied significantly from 97.8 per 100,000 population for the most urban group to 172.1 per 100,000 population for the residents of rural, remote counties. Similarly, total mortality ranged from 18.1 per 100,000 population among residents of the most urban counties to 33.8 among residents of rural, remote counties. Prehospital mortality ranged from 10.0 to 27.7 traumatic brain injuries per 100,000 population. CONCLUSIONS: These results provide justification for expanding efforts to prevent traumatic brain injury to include the small, but high-risk group of residents in rural areas.

Adolescent↗
PubMed2005

Temporally distinct Escherichia coli 0157 outbreaks associated with alfalfa sprouts linked to a common seed source--Colorado and Minnesota, 2003.

Escherichia coli O157 outbreaks were identified in Minnesota in February 2003 involving seven persons and in Colorado in July 2003 involving 13 persons. Case isolates from the two states had matching pulsed-field gel electrophoresis (PFGE) patterns. Independent case-control studies linked infections in each outbreak with eating alfalfa sprouts that were traced to the same seed distributor. The Colorado sprouter reportedly complied with the Food and Drug Administration (FDA) sprout guidance, whereas the Minnesota sprouter did not. These investigations revealed that increased compliance with existing FDA guidance is needed and that additional research is needed to improve the alfalfa seed decontamination process. This reaffirms the FDA recommendation that raw alfalfa sprouts should be considered potentially contaminated and avoided by persons at high-risk such as the elderly, young children, and immunocompromised persons. PFGE played an essential role in linking these two temporally and geographically distinct E. coli O157 outbreaks.

Adult↗
PubMed2001

Colorado family physicians' knowledge of hereditary breast cancer and related practice.

BACKGROUND: The objective of this study was to describe Colorado family physicians' (FPs') knowledge of hereditary breast cancer and related practice behaviors. METHOD: A survey was mailed to 400 practicing FPs randomly sampled from the board-certified members of the Colorado Academy of Family physicians. RESULTS: Overall, knowledge of hereditary breast cancer was inadequate. Less than half of the respondents knew that BRCA mutations account for 0-10% of all breast cancers; 38% knew the lifetime risk for non-carriers, and 17% responded that a known carrier would have a lifetime breast cancer risk of 50%. Just 45% knew that a BRCA1 mutation could pass from father to daughter. Similarly, only half reported an increased ovarian cancer risk for BRCA1 carriers, and an increased risk for male breast cancer for BRCA2 carriers. All respondents reported that taking a family cancer history was part of their regular clinical practices. The majority reported having referred no patient for cancer genetic counseling or testing within the prior year, with only two reporting having ordered BRCA1 or BRCA2 testing within the year. There was no significant sociodemographic or knowledge difference between the physicians who reported referring patients and the others (p > 0.05). There was interest in learning more about hereditary breast cancer, with rural physicians requesting Internet and teleconference courses. CONCLUSIONS: As cancer genetics emerges into the primary care arena. FPs recognize their knowledge deficit in this area. Future cancer genetic outreach for primary care providers statewide is necessary and would be welcomed, and may require a variety of educational and consultative approaches, depending on geographic location of practice.

Adult↗
PubMed1998

Comparison of the prevalence of antibodies to human herpesvirus 8 (Kaposi's sarcoma-associated herpesvirus) in Brazil and Colorado.

The prevalence of human herpesvirus 8 (HHV-8; Kaposi's sarcoma [KS] herpesvirus) infection was determined by IFA in 297 persons living in Brazil and Colorado. The prevalence of antibody to HHV-8 in human immunodeficiency virus (HIV) type 1-seropositive gay men with and without KS was similar in Brazil and Colorado. In Brazil, the prevalence of HHV-8 antibody was significantly greater in HIV-1-seronegative gay men than in HIV-1-seronegative male intravenous drug users. HHV-8-seropositive Brazilian gay men who had a clinical diagnosis of KS or who were infected with HIV-1 had significantly higher titers of HHV-8 antibody than did HHV-8-seropositive, HIV-1-seronegative Brazilian gay men. These findings provide further support for the association between HHV-8 infection and KS and suggest that, as in the United States, HHV-8 infection is transmitted sexually in Brazil.

Adolescent↗
PubMed2000

Transmission of the agent of human granulocytic ehrlichiosis by Ixodes spinipalpis ticks: evidence of an enzootic cycle of dual infection with Borrelia burgdorferi in Northern Colorado.

Previous work described an enzootic cycle of Borrelia burgdorferi sensu lato (hereafter referred to as B. burgdorferi) maintained by the rodent Neotoma mexicana and the tick Ixodes spinipalpis in northern Colorado. We investigated the incidence of coinfection among rodents with the agent of human granulocytic ehrlichiosis (aoHGE). aoHGE was detected in 23.5% of 119 rodent spleens examined. Biopsy results indicated that 78 (65.5%) of the 119 rodents were positive for B. burgdorferi, whereas 22 (78.5%) of the 28 animals that harbored aoHGE were also infected with B. burgdorferi. In 14 of 25 I. spinipalpis tick pools, aoHGE was detected by amplifying both the 16s rRNA and p44 gene of aoHGE. The ability of I. spinipalpis to transmit aoHGE was examined in C3H/HeJ mice. aoHGE was detected in their blood 5 days after I. spinipalpis infestation. This study confirms that both B. burgdorferi and aoHGE can be transmitted by I. spinipalpis ticks and that there is a high incidence of coinfection in rodents, predominantly Peromyscus maniculatus and N. mexicana, that inhabit the foothills of northern Colorado.

Animals↗
PubMed2006

Colorado revised statutes in support of palliative care limiting criminal liability.

Colorado's manslaughter law classifies assisted suicide as a felony. Because terminal patients are close to life's end, death while being treated is inevitable, therefore, there was concern among physicians that the fear of prosecution continued to prevent adequate pain relief for terminal patients. A group of physicians and concerned citizens set out to amend Colorado Revised Statutes to reassure doctors and others prescribing or administering palliative care for terminal patients that they would not be indicted under the law prohibiting assisted suicide. The 2006 Assembly passed the amendment (quoted in the text) with virtually no opposition in either house and it was signed into law by the governor, effective July 6, 2006. Note that in addition to allowing appropriate pain management, it specifically emphasizes that it does not permit assisted suicide.

Colorado↗
PubMed1989

Normal vitamin E status in sickle hemoglobinopathies in Colorado.

Because previous studies of serum or plasma vitamin E (E) levels reported a high prevalence of E deficiency in patients with sickle cell anemia (SCA), we studied the E status in 101 patients with SCA in Colorado using both levels of serum E and ratios of serum E to total lipid (E:L). Compared with age-, sex-, and race-matched controls, 1 of 70 patients with homozygous SCA (SS), 1 of 7 with sickle beta+-thalassemia, and 0 of 24 with hemoglobin SC disease had E deficiency according to E:L and all were E-sufficient based on serum E levels. Serum cholesterol levels, lower in SS patients than in control subjects, correlated more strongly with serum E levels than did total serum lipid levels in control subjects and SS patients; hence, the ratio of serum E to cholesterol may be a useful indicator of E status in these patients. We conclude that vitamin E deficiency rarely occurs in SCA patients in Colorado.

Adolescent↗
PubMed1985

Virus-induced leukopenia: Colorado tick fever as a human model.

Eight patients with Colorado tick fever were studied to determine whether alterations in the production of granulopoietic stimulatory or inhibitory factors (or both) could be found in association with the leukopenic state of the disease. The studies demonstrate that in the patients with Colorado tick fever the mononuclear cell production of colony-stimulating factor is decreased and that there is an increase in circulating inhibitory factors in the serum of such patients. The depressed mononuclear cell colony-stimulating activity does not appear to be reversible by addition of either endotoxin or normal human serum. Characterization of these serum inhibitory factors may facilitate understanding of leukopenia in human disease.

Adult↗
PubMed1994

Discovery of an enzootic cycle of Borrelia burgdorferi in Neotoma mexicana and Ixodes spinipalpis from northern Colorado, an area where Lyme disease is nonendemic.

An intensive enzootic cycle of Borrelia burgdorferi was seen in populations of the Mexican wood rat, Neotoma mexicana, and Ixodes spinipalpis ticks in northern Colorado. Cultures of rodent ear tissue and ticks yielded 63 spirochetal isolates: 38 N. mexicana, 2 Peromyscus difficilis, and 23 I. spinipalpis. All 63 isolates were identified as B. burgdorferi sensu lato by polymerase chain reaction; a representative subset was characterized as B. burgdorferi by SDS-PAGE and immunoblotting. A tick-derived spirochete isolate was infectious to laboratory mice and I. scapularis, the principal vector of Lyme disease in endemic areas of the United States. The risk of human contact with infected I. spinipalpis appears to be minimal from this epidemiologically silent focus in northern Colorado, since this tick is restricted to wood rat nests in this semiarid environment.

Animals↗
PubMed1997

Regional molecular genetic key of thirteen snow pool Aedes species (Diptera:Culicidae) in northern Colorado.

Snow pool Aedes mosquitoes are identified easily and accurately by microscopic examination of 4th instars or male genitalia. Early instars and females cannot be identified accurately. We demonstrate that restriction fragment-length polymorphisms (RFLP) in the internal transcribed spacer (ITS) of the nuclear ribosomal DNA cistron are specific to each of 13 snow pool Aedes species found in northern Colorado. The ITS was amplified by the polymerase chain reaction (PCR) and digested with AluI and MspI restriction endonucleases. Differences in the sizes of digested fragments among the 13 species were so slight that they could only be resolved with polyacrylamide gel electrophoresis and visualized with silver staining. A key to species found in the Rocky Mountains of northern Colorado was constructed using the PCR-RFLP patterns. Three of the species were collected in California and had identical PCR-RFLP patterns, indicating that restriction sites in the ITS may be conserved within some species.

Aedes↗
PubMed1997

Plasma apolipoprotein A-I, apolipoprotein B, and lipoprotein(a) concentrations in normoglycemic Hispanics and non-Hispanic whites from the San Luis Valley, Colorado.

Lower levels of plasma apolipoprotein (apo) A-I and higher levels of apoB, lipoprotein(a) (Lp(a)), and the ratio of apoB to apoA-I are considered to be independent risk factors for coronary heart disease. To examine race differences in the distributions of plasma levels of apoA-I, apoB, and Lp(a), the authors have determined quantitative levels of these traits in 252 nondiabetic Hispanics and 459 nondiabetic non-Hispanic whites (NHWs) from the San Luis Valley, Colorado. Hispanic men and women, respectively, had significantly higher plasma apoB levels (p < 0.003; p < 0.01) and the ratio of apoB to apoA-I (p < 0.003; p < 0.0003) than their NHW counterparts. Plasma Lp(a) concentrations were also significantly higher in Hispanic men (p < 0.003) and apoA-I levels were significantly lower in Hispanic women (p < 0.0003) than NHW men and women, respectively. Overall, the threshold points of apoA-I (< 120 mg/dl), apoB (> 120 mg/dl), and Lp(a) (> 25 mg/dl) were higher in Hispanics than in NHWs for apoA-I (22.8 vs. 15.7%), apoB (16.9 vs. 9.9%), and Lp(a) (18.6 vs. 12.4%). These data suggest that the quantitative risk profile for coronary heart disease with respect to these three quantitative traits is not favorable for Hispanics compared with that for NHWs in the San Luis Valley, Colorado.

Adult↗
PubMedDate not supplied

Linking people with traumatic brain injury to services: successes and challenges in Colorado.

People with traumatic brain injury (TBI)-related disability often need services and other types of support to return to productive lives; thus, improving access to available TBI services is a priority for a variety of states' agencies, such as Human Services and Public Health. Although infrastructure and resources vary from state to state, each can benefit by learning about how other states link people with TBI to services. In this report, we summarize Colorado's experience in exploring and developing better ways to link state residents with TBI to services. Recommendations for improving the system of linking people to services in Colorado included the following: (1) expanding the population targeted for linkage to services beyond those who are hospitalized; (2) improving access to information about available services; and (3) increasing the availability of services.

Brain Injuries↗
PubMed1992

Incidence of insulin-dependent diabetes mellitus in Colorado.

We examined the incidence of insulin-dependent diabetes mellitus in children 0-17 years of age in Colorado from 1978 to 1988. Cases were ascertained from a statewide registry based on physician surveillance. A total of 1,376 children were diagnosed during this interval in a population averaging 860,000 children. The degree of ascertainment was estimated to be 93.3%. The age-adjusted incidence rate of insulin-dependent diabetes mellitus was 14.8/100,000 person-years. The rate was lower in individuals of Spanish origin (Hispanics) (8.7/100,000 person-years) compared with non-Hispanic individuals (15.5/100,000 person-years) (incidence rate ratio = 0.6, 95% confidence interval = 0.4-0.8). Incidence rates were higher in winter and lower in summer for children 5-17 years old. Children diagnosed before the age of 5 years showed no significant seasonal pattern, although peak incidences were observed in autumn and spring. No temporal trend in diabetes incidence was observed overall or by ethnic group. The increasing insulin-dependent diabetes incidence reported by registries in Europe during this time period was not observed in Colorado.

Adolescent↗
PubMed2001

The Interdisciplinary Generalist Curriculum Project at the University of Colorado School of Medicine.

The University of Colorado School of Medicine first considered a longitudinal primary care preceptorship in 1992, when the dean formed the dean's Ad Hoc Committee to launch the "generalist initiative," to include a three-year required longitudinal generalist preceptorship. Being awarded an Interdisciplinary Generalist Curriculum (IGC) Project contract provided the dean's Ad Hoc Committee with the momentum it needed to enact the curriculum. This article describes the IGC Project at the University of Colorado as it was originally proposed and the intended and unintended outcomes over time. Intended outcomes included establishing early continuous clinical experiences as a vital part of the curriculum and increased exposure to primary care, while examples of unintended outcomes were the development of a longitudinal skill and behavior evaluation process and the integration of problem-based learning in the curriculum. The article concludes with a description of what is ahead for the curriculum.

Colorado↗
PubMed1998

Modifiers of lung cancer risk in uranium miners from the Colorado Plateau.

Given the scientific consensus that exposure to radon decay products causes lung cancer, most recent studies have focused on the nature of the exposure-response relationship. Since residential radon exposure is now a primary public health issue, a better understanding of the effects of low levels of radon as well as factors modifying risk estimates has become very important. Several factors are shown to affect risk estimates in the latest update of the vital status follow-up (through 1990) and smoking history for the cohort of underground uranium miners in the Colorado Plateau. This analysis confirms earlier results indicating a strong dependence of relative risk estimates upon attained age. Quantitative estimates of relative risk as a function of cumulative exposure to radon decay products (WLM) are provided for three age strata. The non-linearity often reported in the Colorado Plateau data is shown to be at least partially due to an inverse exposure-rate effect, i.e., low exposure rates for long periods are more hazardous than equivalent cumulative exposure received at higher rates for shorter periods of time. However, this effect is shown to diminish at lower exposure rates and cumulative exposures. In addition, use of the new smoking data indicates that the radon/smoking interaction is submultiplicative and may depend upon attained age.

Aged↗
PubMed1999

Plutonium contamination in soils in open space and residential areas near Rocky Flats, Colorado.

Spatial analysis of the 240Pu:239Pu isotopic ratio of 42 soil samples collected around Rocky Flats Plant near Golden, Colorado, was conducted to assess the effect of Rocky Flats Plant activity on the soil environment. Two probability maps that quantified the uncertainty of the spatial distribution of plutonium isotopic ratios were constructed using the sequential Gaussian simulation technique (sGs). Assuming a plutonium isotopic ratio range of 0.152+/-0.003 to 0.169+/-0.009 is characteristic to global fallout in Colorado, and a mean value of 0.155 is representative for the Rocky Flats Plant area, the main findings of the current work were (1) the areas northwest and southwest of Rocky Flats Plant exhibited a plutonium ratio > or = 0.155, thus were minimally impacted by the plant activity; (2) the study area east of Rocky Flats Plant (approximately 120 km2) exhibited a plutonium isotopic ratio < or = 0.155, which is a definitive indicator of Rocky Flats Plant-derived plutonium; and (3) inventory calculations across the study area exhibited large standard error of estimates. These errors were originated from the high variability in plutonium activity over a small sampling scale and the uncertainty in the global fallout isotopic ratio. Using the mean simulated estimates of plutonium isotopic ratio, coupled with plutonium activity measured at 11 soil pits and additional plutonium information published elsewhere, the plutonium loading on the open space and residential areas amounted to 111.2 GBq, with a standard error of estimate of 50.8 GBq.

Algorithms↗
PubMed1988

EMS response to a ski lift disaster in the Colorado mountains.

The EMS system in a Colorado mountain community was tested by the fall of a ski lift injuring 49 people. The response was complicated by the remote location of the accident and the number of injuries. Use of a preconceived disaster plan reduced morbidity and mortality. Patients were stabilized and triaged at the disaster site, and transported to the Snake River Health Services, Inc., where a second level of triage occurred. ATLS was provided at the Snake River Health Services and patients were transported to various surgical facilities throughout Colorado. Because a disaster in a remote or rural area can more easily overwhelm available resources, physicians should ensure that a good disaster plan is in place, should be able to provide initial evaluation and stabilization of patients, and arrange transport to the nearest appropriate facility.

Aircraft↗
PubMed1988

The role of a regional trauma system in the management of a mass disaster: an analysis of the Keystone, Colorado, chairlift accident.

On December 14, 1985, the Teller chairlift at the Keystone, Colorado, ski area collapsed, throwing 60 of the 372 people aboard to the ground from heights up to 50 feet. Initial triage and management of the victims was carried out by the local ski patrol, the on-duty physician at the area's Snake River Health Services Clinic, and by volunteer physicians and nurses present at the scene. Thirty-three people required immediate evacuation to hospitals, most of them being transported 75 miles by helicopter air ambulance to level I and II trauma centers in the Denver metropolitan area. Eighteen of these air-evacuated patients were in serious or critical condition. Less seriously injured victims were treated at local medical facilities. The scene evacuation was carried out by helicopter and ground vehicles in accordance with an existing disaster plan coordinated by the Colorado Trauma Institute (CTI). The unique problems posed by a mass casualty incident in a remote mountain location are emphasized by this tragedy. Patient salvage due to the efficacy of a regionally organized trauma system is clearly demonstrated.

Adolescent↗