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PubMed1993

Replication of Colorado tick fever virus within human hematopoietic progenitor cells.

Significant neutropenia, as well as thrombocytopenia and a mild anemia, occurs in patients infected with Colorado tick fever virus. In this study, human bone marrow CD34+ cells and KG-1a cells, a human hematopoietic progenitor cell line, were infected in vitro with Colorado tick fever virus. The time course and morphological appearance of viral replication in human progenitor cells were similar to those seen in erythroblasts and in HEL cells and suggest one possible mechanism for the clinical hematologic findings.

Animals↗
PubMed2003

Farm work practices and farm injuries in Colorado.

STUDY OBJECTIVE: s: To describe the farm work patterns and the relationship between hours spent working on specific farm tasks and task specific work related injuries among women and men. DESIGN: A cross sectional survey of farm operators and their spouses in an eight county area of Colorado was conducted. Personal interviews were conducted between 1993 and 1997. Interviews took between 45 minutes to two hours to complete, depending on the complexity of individuals' personal histories. Farms were selected using stratified random sampling technique. SETTING: Eight counties in Northeastern Colorado representing 47% of agricultural production in the state. PARTICIPANTS: A total of 301 women and 459 men who were farm residents and involved in farm work were recruited. OUTCOME MEASURE: Self reported injuries resulting in medical attention or treatment other than first aid, or inability to do normal work activities, or loss of consciousness, or transfer to another job were assessed in relationship to the specific job task being performed at the time of the injury. RESULTS: Women were at higher risk for injury than men when involved with other farm chores (rate ratio 8.18). For all other task related injuries, men and women were at similar risk when compared using hours of exposure to the farm tasks. CONCLUSION: Farm safety training and injury prevention programs need to include women working on farms.

Agricultural Workers' Diseases↗
PubMed2002

Risk network structure in the early epidemic phase of HIV transmission in Colorado Springs.

This study describes the risk network structure of persons with HIV infection during its early epidemic phase in Colorado Springs, USA, using analysis of community-wide HIV/AIDS contact tracing records (sexual and injecting drug partners) from 1985 to 1999. Paired partner information from other STD/HIV programme records was used to augment network connections. Analyses were conducted with and without this supplemental information. The results suggest that a combined dendritic and cyclic structural network pattern is associated with low to moderate HIV propagation in Colorado Springs, and may account for the absence of intense propagation of the virus.

Adolescent↗
PubMed2002

The impact of managed care on cross-system use of mental health services by veterans in Colorado.

OBJECTIVES: Some state mental health systems have implemented capitated managed care as a strategy for lowering mental health care costs. There has been concern that this strategy has left vulnerable populations at risk of not being able to obtain adequate care. This study examined whether the advent of managed care in Colorado resulted in lower rates of use of both state and Department of Veterans Affairs (VA) mental health care services (cross-system use). METHODS: A cohort of 10,950 veterans who had used VA mental health services between 1995 and 1997 were studied to determine whether veterans who lived in counties that had implemented managed care were less likely to be cross-system users over time. VA data were matched with state mental health data to determine who was using both types of services. RESULTS: Rates of cross-system use were generally low. Veterans who lived in a county that had implemented managed care were less likely to be cross-system users than veterans who lived in other counties. However, the proportions of cross system users in managed care counties and in other counties did not change significantly over time. Veterans who were cross-system users were more likely to be younger, to live farther away from a VA hospital and closer to a non-VA hospital, and to have received inpatient VA care. CONCLUSIONS: The implementation of managed care in Colorado did not appear to have affected rates of cross-system use of state and VA mental health care.

Colorado↗
PubMed2005

Medication treatment patterns for adults with schizophrenia in Medicaid managed care in Colorado.

OBJECTIVE: This study investigated the impact of Colorado's Medicaid mental health managed care program on patterns of antipsychotic medication treatment among persons with a diagnosis of schizophrenia. These patterns were compared with patterns of psychosocial treatment and a measure of symptom change. METHODS: Changes in study measures over time in two areas of the state where the policy intervention was implemented were compared with changes in measures in areas where it was not implemented. The study sample consisted of 235 consumers. Measures of antipsychotic medication treatment included any use in a given period, months in which a prescription was filled, and use of second-generation antipsychotics. Psychosocial treatment was measured by any use and expenditures per user. The schizophrenia subscale of the Brief Psychiatric Rating Scale was used to measure consumer outcomes. RESULTS: Probabilities of antipsychotic use in the managed care areas were stable or increased compared with the other areas. The average number of months with filled prescriptions was unchanged. Consumers served under managed care were less likely to use psychosocial treatment, and additional decreases in treatment costs were noted in one area. Difference scores for the schizophrenia subscale showed no change or positive effects for the managed care areas. CONCLUSIONS: Within the Colorado managed care program, antipsychotic medication therapy was not impaired, despite significant decreases in the continuity or intensity of psychosocial treatment, and no reduction in symptom levels was noted. Mental health managed care does not inherently impair medication therapy. Patterns of medication use appeared to be better indicators of program success than psychosocial treatment patterns and were more consistent with outcomes.

Adult↗
PubMed2006

Maternal risk factors for term neonatal seizures: population-based study in Colorado, 1989-2003.

Neonatal seizures in term infants are rare but have important potential implications for brain development. Risk factors for neonatal seizures in term infants have been less well defined than those among preterm infants. To evaluate the relationship between maternal risk factors and neonatal seizures in the first 72 hours of life in term infants, a case-control study using the Colorado Birth Certificate Registry was conducted. Term neonates in all hospitals in Colorado with and without seizures in the first 72 hours were studied. After adjusting for vaginal delivery in the setting of herpes infection and post-term delivery, preexisting diabetes in the mother (odds ratio 4.30, 95% confidence interval 1.64-11.27, P < .01) and fetal distress (odds ratio 5.88, 95% confidence interval 4.60-7.13, P < .0001) were independent risk factors for neonatal seizures in term infants. These findings are confirmatory of previous reports that maternal preexisting diabetes and fetal distress increase the risk of neonatal seizure in term infants. Although we cannot establish the pathophysiology of neonatal seizures from this analysis, hypoxic-ischemic brain injury and hypoglycemia in infants of diabetic mothers are known causes of neonatal seizures that can be represented in this analysis by fetal distress and maternal preexisting diabetes, respectively. Maternal diabetic vasculopathy can also be a contributing factor.

Adolescent↗
PubMed2004

Breastfeeding practices in Colorado businesses.

The Colorado Worksite Infant Feeding Survey was used to examine breastfeeding support policies and practices within Colorado businesses. Only 28.2% of survey respondents reported that their organization provided breastfeeding support services. However, the majority of businesses did offer benefits and services conducive to breastfeeding. There was a low frequency of positive responses related to incentives for increasing the provision of breastfeeding support services. The incentives receiving the highest frequency of positive responses were those related to employer benefits and needs, such as provision of information on successful breastfeeding support programs within similar organizations; provision of information on the benefits of breastfeeding to employers, including cost savings; and availability of tax credits for providing breastfeeding support services. Multiple approaches are indicated for increasing work-site breastfeeding support and for removing barriers to the achievement of Healthy People 2010 breastfeeding objectives for employed mothers.

Adult↗
PubMedDate not supplied

Partner notification for human immunodeficiency virus infection in Colorado: results across index case groups and costs.

To evaluate human immunodeficiency virus (HIV) partner notification and referral across index case groups, we analysed results of services provided by the Colorado Department of Health during 1988. Services were offered to 231 index cases; 226 (98%) accepted; 124 (65%) with unsafe behaviours identified 239 partners; 79% of partners were notified; 68% accepted counselling. Seropositivity was 21% in newly tested partners. Index cases chose patient referral for 25% of partners and referred 20% of eligible partners; the provider referred 71%. Index case acceptance of service, proportion of index cases with newly identified HIV positive partners, and choice of partner referral method were similar across groups. Gay men identified fewer partners, had a lower proportion of partners accepting new counselling and testing and referred a lower proportion of partners than heterosexual men. The total costs of the service were $19,496. Twelve new cases of HIV were identified through patient and provider referral and cost per case identified was $1625. Partner notification and provider referral should be offered to all HIV infected individuals in Colorado, as few differences across groups emerged and only 20% of located and eligible partners received counselling through patient referral.

Colorado↗
PubMed2003

Survey of cattle in northeast Colorado for evidence of chronic wasting disease: geographical and high-risk targeted sample.

A geographically targeted survey of potentially high-risk, adult cattle in chronic wasting disease (CWD)-endemic areas in Colorado was initiated to assess the possibility of the spread of CWD from deer to cattle under natural conditions. Surveyed cattle were sympatric with free-roaming deer in geographically defined areas where CWD occurs and where CWD prevalence has been estimated. To qualify for inclusion in the survey, cattle had to be at least 4 years old and had to have spent a minimum of 4 years in surveyed areas. Brains from culled cattle were examined microscopically and immunohistochemically for tissue alterations indicative of a transmissible spongiform encephalopathy (TSE). Two hundred sixty-two brains were suitable for evaluation and were found to lack changes indicative of a TSE infection. Prion deposition was not demonstrable using a method involving formic acid and proteinase-K treatment before application of monoclonal antibody to bovine prion protein (F99/97.6.1). Some incidental neuropathologic changes unrelated to those of TSEs were detected. Findings from this study suggest that large-scale spread of CWD from deer to cattle under natural range conditions in CWD-endemic areas of northeast Colorado is unlikely.

Animals↗
PubMedDate not supplied

Pharmacists' attitudes and concerns regarding syringe sales to injection drug users in Denver, Colorado.

OBJECTIVE: To identify factors influencing pharmacists' decisions about selling syringes to injection drug users (IDUs). DESIGN: Audiotaped interviews. SETTING: Denver, Colorado. PARTICIPANTS: Thirty-two pharmacists at 24 pharmacies. INTERVENTION: One-hour semistructured interviews. MAIN OUTCOME MEASURES: Practices regarding syringe sales to IDUs and factors influencing the practices. RESULTS: Of the 32 pharmacists interviewed, 16 indicated that they sold syringes to all customers ("pro-sell"), 11 refused to sell unless shown proof of diabetic status ("no-sell"), and 5 were "undecided." Several factors influenced the decision to sell. A perceived conflict between prevention of disease and prevention of drug abuse most clearly distinguished the three categories, with pro-sell pharmacists more likely than others to prioritize disease prevention and believe that syringe sales would not increase drug abuse. Business concerns, such as the effect of the presence of IDUs on other customers and the possibility of discarded syringes around the store, were especially prevalent among no-sell and undecided pharmacists. Seventeen pharmacists did not know about Colorado laws governing syringe sales. Four no-sell pharmacists used the laws to justify their decision not to sell, and two undecided pharmacists said they used the law when they did not want to sell syringes to IDU. All pharmacists supported syringe exchange programs. CONCLUSION: One-half of the pharmacists sold syringes to IDUs, and several more indicated that they would do so if certain concerns were addressed. These data suggest that improved syringe disposal options, continuing education programs, and clarification of existing laws and regulations would encourage more pharmacists in Denver to sell syringes to IDUs.

Attitude of Health Personnel↗
PubMedDate not supplied

Kaiser Permanente Colorado Region Pharmacy Department: innovative leader in pharmacy practice.

OBJECTIVE: To describe innovative programs within the Kaiser Permanente Pharmacy Department in the Colorado Region. SETTING: One of eight regions of the nation's largest nonprofit health maintenance organization. PRACTICE DESCRIPTION: The pharmacy department comprises two services, Clinical Pharmacy Services and Pharmacy Operations/Support Services, which are integrated to provide comprehensive care. PRACTICE INNOVATION: Within Clinical Pharmacy Services, the Primary Care Clinical Pharmacy Services team works alongside physicians to provide integrated patient care. The Centralized Clinical Pharmacy Service teams manage large groups of patients effectively and efficiently. The Clinical Pharmacy Specialty staff and the Disease State Management clinical pharmacy specialists provide focused drug therapy expertise. MAIN OUTCOME MEASURES: Clinical and economic outcomes; recognition by national organizations. RESULTS: Technological innovations are used within Pharmacy Operations/Support Services to increase pharmacists' time for patient care activities. The use of technology by the Pharmacy Automated Refill Center and the implementation of ScriptPro in the medical office pharmacies decrease dispensing demands by processing large volumes of prescriptions. Workflow in the medical office pharmacies has also been reengineered to increase efficiency. Various programs have been developed by the Pharmacy Information Technology Service to support patient care initiatives. Benchmark clinical and economic outcomes have been demonstrated. Positive outcomes have also resulted in quality and safety awards and captured the attention of national pharmacy and medical organizations. CONCLUSION: The Colorado Region Pharmacy Department has been recognized as a leader in pharmacy practice through the development of innovative services that provide exceptional patient care.

Anticoagulants↗
PubMed2000

Colorado potato beetle (Coleoptera: Chrysomelidae) feeding, development, and survival to adulthood after continuous exposure to Bacillus thuringiensis subsp. tenebrionis-treated potato foliage from the field.

Colorado potato beetle, Leptinotarsa decemlineata (Say), feeding, development, and survival to adulthood were examined after continuously exposing large larvae to Bacillus thuringiensis subsp. tenebrionis-treated potato foliage from the field. In laboratory assays, the overall consumption and the length of period to become prepupae were determined for larvae, which began as 3rd and 4th instars, that were offered potato leaf disks with naturally declining levels of B. thuringiensis residue. In small-cage field experiments, survival to adulthood and the period to adult emergence for beetles confined to potato plants treated with B. thuringiensis beginning as 3rd and 4th instars also were examined. Third instars remaining on plants after a B. thuringiensis application were unlikely to feed and 4th instars consumed only approximately 50% as much foliage as those fed untreated foliage. Many late instars subjected to B. thuringiensis-treated foliage failed to survive to adulthood; 58-83% of these beetles died during the larval stage. Reduced feeding and poor survival of late instars suggest that counts of large larvae after application do not provide a complete picture of the efficacy of the B. thuringiensis treatment. Late instar Colorado potato beetles that were exposed continually to naturally declining levels of B. thuringiensis-treated potato foliage took an average of 1.8-4.5 d longer to become prepupae and 4-8 d longer to emerge as adults compared with those provided with untreated foliage. Delayed emergence of adults that fed on B. thuringiensis-treated potatoes as late instars indicated that development was prolonged in these insects because of ingestion of a sublethal dose of B. thuringiensis.

Animals↗
PubMed2001

Occurrence of Anopheles hermsi (Diptera: Culicidae) in Arizona and Colorado.

Historically, malaria was a significant cause of morbidity and mortality throughout the western United States, and Anopheles freeborni Aitken was thought to be the vector west of the Continental Divide. In 1989, Anopheles hermsi Barr & Guptavanij was described and subsequently found to be an effective laboratory vector of Plasmodium. The adults of these two species are morphologically indistinguishable, and therefore polymerase chain reaction was used to analyze the DNA from 48 mosquitoes collected in Arizona and Colorado (identified morphologically as An. freeborni). All specimens were identified as An. hermsi. This was the first report of An. hermsi in Arizona and Colorado and indicated that this Anopheles species historically may have been a malaria vector in these two western states.

Animals↗
PubMed2001

Isolation and characterization of Borrelia parkeri in Ornithodoros parkeri (Ixodida: Argasidae) collected in Colorado.

This study describes the identification of Borrelia parkeri spirochetes in Colorado. Two isolates of B. parkeri (6230 and 6232) were recovered from Ornithodoros parkeri Cooley ticks collected at an inactive prairie dog town in Moffat County. Both isolates were partially characterized by sequencing and subsequent parsimony and neighbor-joining analyses of appropriate regions of the 16S ribosomal RNA, flagellin and P66 genes. Analyses of the 16S gene sequences from the Colorado isolates indicated that they were more closely related to B. parkeri and B. tucatae than to B. hermsii or the other species of Borrelia investigated in this study. Additional analyses of amino acid sequences for flagellin and P66, however, clearly demonstrated that isolates 6230 and 6232 were most closely related to B. parkeri. The possible significance of B. parkeri as an agent of human disease is discussed.

Animals↗
PubMed2000

The effect of capitated financing on mental health services for children and youth: the Colorado experience.

OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.

Adolescent↗
PubMed1988

Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry.

The hypothesis that breast-feeding can provide protection against the development of insulin-dependent diabetes mellitus (IDDM) and would, therefore, be less common among subjects with IDDM was tested with a retrospective design. Cases (n = 268) were selected from the Colorado IDDM Registry and the Barbara Davis Center for Childhood Diabetes (Denver, CO). Two control groups were recruited, one from physicians' practices throughout Colorado (n = 291) and the second through random-digit dialing from the Denver area (n = 188). Cases were less likely to have been breast-fed than controls after adjustment for birth year, maternal age, maternal education, family income, race, and sex [adjusted odds ratio (OR) = 0.70; 95% confidence interval (CI) = 0.50-0.97]. This finding was consistent for both control groups and by birth-year intervals. A greater decrease in risk of IDDM was seen among subjects who had been breast-fed to an older age (for breast-feeding duration of greater than or equal to 12 mo, adjusted OR = 0.54, 95% CI = 0.27-1.08). The amount of IDDM that might be explained by breast-feeding habits (population percentage attributable risk) ranged from 2 to 26%, varying according to the breast-feeding prevalence reported in other studies. Replication of this work in different populations, controlled for the strong secular trends in breast-feeding habits, is critical before the hypothesis of protection is accepted.

Breast Feeding↗
PubMed1990

Colorado IDDM Registry. Incidence and validation of IDDM in children aged 0-17 yr.

The purpose of this study was to determine the incidence of insulin-dependent diabetes mellitus (IDDM) among children aged 0-17 yr for age, sex, season, and urban and rural residence of onset in Colorado. Retrospective registration of new-onset cases was conducted from 1978 to 1980, and then prospective registration continued through 1983 with the use of physician reporting with hospital validation. The annual incidence of IDDM was 15.2/100,000 per year (95% confidence interval [CI] 14.1, 16.3), with little difference between the sexes. The highest incidence was in the 10- to 14-yr age-group for both sexes. There was a seasonal peak of winter onset in those aged 10-17 yr, with similar patterns between sex and ethnic groups. No temporal trend over the 6 yr was seen, although an excess of cases was seen for 15- to 17-yr-old boys in 1980-1982. Rates were similar for urban and rural areas of the state. Case ascertainment was estimated to be 93.2% complete (95% CI 91.5, 95.5). Incidence was similar in Colorado to other populations in the United States at similar latitudes. These data serve as a baseline for evaluation of changes in incidence over time, by region, and for the identification of possible outbreaks.

Adolescent↗
PubMed2005

Secondary attack rate of type 1 diabetes in Colorado families.

OBJECTIVE: Families of children diagnosed with type 1 diabetes require counseling concerning type 1 diabetes risk in nondiabetic siblings and parents. No U.S. population-specific life-table risk estimates are currently available for parents, and those for siblings (2-6% by age 20 years) are based on family studies completed before 1987. RESEARCH DESIGN AND METHODS: We analyzed family histories of 1,586 patients in Colorado with type 1 diabetes (83% non-Hispanic white, 10% Hispanic, and 7% other) diagnosed before 16 years of age and interviewed during 1999-2002. Families of probands with type 2, undetermined, or secondary diabetes (n = 53) or those with incomplete data (n = 137) were excluded. The median age at onset of the proband was 7.1 years and the median diabetes duration 3.5 years. Cumulative risk estimates were calculated using survival analysis for 2,081 full siblings and 3,016 biological parents. RESULTS: In siblings, the overall risk of type 1 diabetes by age 20 years was 4.4%, but it was significantly (P < 0.0001) higher in siblings of probands diagnosed under age 7 years than in those diagnosed later. In parents, the overall risk by age 40 years was 2.6% and higher in fathers (3.6%) than in mothers (1.7%) of probands (P < 0.001). Similar to siblings, the risk was also higher (P = 0.006) in parents of probands diagnosed <7 years of age than in those diagnosed later. CONCLUSIONS: Current risks of type 1 diabetes in Colorado siblings and parents of type 1 diabetic probands are higher than in the 1982 Pittsburgh study but similar to contemporary European rates. Recurrence risk of type 1 diabetes is significantly higher in first-degree relatives of probands diagnosed at a young age.

Adult↗