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PubMed1994

Prevalence of penicillin-resistant Streptococcus pneumoniae--Connecticut, 1992-1993.

Streptococcus pneumoniae is an important cause of community-acquired bacterial pneumonia, meningitis, acute otitis media, and other infections. Infants, young children, and the elderly are most severely affected by pneumococcal disease. Although S. pneumoniae was once considered to be routinely susceptible to penicillin, since the mid-1980s the incidence of resistance of this organism to penicillin and other antimicrobial agents has been increasing in the United States. National surveillance for drug-resistant S. pneumoniae (DRSP) is limited to testing invasive isolates from sentinel hospitals in 13 states. To determine the extent of antimicrobial susceptibility testing of S. pneumoniae and the prevalence of penicillin resistance among pneumococcal isolates from July 1992 through June 1993, in August 1993 the Connecticut Department of Public Health and Addiction Services (DPHAS) surveyed all 44 hospitals with clinical microbiology laboratories in Connecticut. This report summarizes the results of that survey.

Connecticut↗
PubMed1993

Physician reporting of Lyme disease--Connecticut, 1991-1992.

Although disease reporting by physicians is an essential component of public health surveillance, the extent of physician participation in reporting specific diseases is not routinely assessed. As part of an evaluation of Lyme disease (LD) surveillance, the Connecticut Department of Health Services (CDHS) conducted a study to determine the number and specialty of Connecticut physicians who reported LD cases in 1991 and/or 1992. This report summarizes the results of this study.

Connecticut↗
PubMed1993

"Where have all the children gone"? Inpatient pediatric care in Connecticut.

Admission of children to hospitals in Connecticut dropped precipitously from 1981 to 1991. Regionalization of pediatric inpatient care is happening without plan. Connecticut data show a change in case-mix of pediatric cases, especially in surgical services and child mental illness categories. Planning for pediatric inpatient services should include considerations of case-mix, cost, and especially, quality of care in general hospital pediatric units with very low volume.

Adolescent↗
PubMed1996

Human rabies--Connecticut, 1995.

On October 3, 1995, a 13-year-old girl who resided in Greenwich, Connecticut, died from rabies virus infection. This was the first case of human rabies reported in a Connecticut resident since 1932. This report summarizes the investigation of this case which indicated a bat as the probable source of her exposure.

Adolescent↗
PubMed1996

Family history of breast and ovarian cancer among breast-cancer patients in the Connecticut Tumor Registry.

Using the database of the population-based Connecticut Tumor Registry (CTR), along with the supplemental data obtained from Connecticut hospitals, 111 cases reporting one or more first-degree relatives with breast and/or ovarian cancer were identified among 1,077 incident female breast-cancer patients diagnosed at age <60 years in 1992. Stage at diagnosis and histology for invasive cancers did not differ between 99 family history-positive cases and 320 cases with no family history of any cancer. The CTR could be useful in clinical and epidemiologic studies involving inherited susceptibility to breast-cancer.

Adult↗
PubMed1996

Reported pap test use by Hispanic women in Connecticut and Long Island.

Some 308 Hispanic adult women 20 to 74 years of age living in Connecticut and Long Island (New York) were interviewed by telephone in February-May 1992. Respondents interviewed in Spanish (46% of the 308) had lower rates of awareness and use of Pap tests than women interviewed in English, and level of education was inversely associated with use of Pap tests. In a multivariate analysis, statistically significant predictors of reporting a recent Pap test (ie, in 1991-92) were whether or not the respondent had a health-care visit during the past year, educational level, and language of interview. The proportion of women who had ever heard of a Pap test was lower in Connecticut than in Long Island women, even after adjusting for differences in sociodemographic characteristics; among those who had ever heard of Pap tests, use was similar for the two areas. Overcoming barriers to health-care access, along with bilingual educational efforts by physicians and public health workers, are needed to increase Pap test use by Hispanic women and reduce their relatively high incidence rates for invasive cervical cancer.

Adult↗
PubMed1997

A thirty-eight year comparison of cancer incidence and mortality among employees at a Connecticut chemical plant.

An important aspect of occupational mortality is the fact that death registration is complete and has good specificity and sensitivity for those cancers with poor survival. However, if available and complete, cancer incidence data are preferable. A unique opportunity presented itself at The Dow Chemical Company's Allyn's Point plant (Gales Ferry, Connecticut) to conduct a cancer incidence and mortality study since the plant began operation in 1951, several years after the establishment of the Connecticut Tumor Registry. All male employees (N = 666) with one or more years of service from 1951-1989 were eligible for the study. Altogether there were 47 primary incident cancers which represented 40 individuals. The Standardized Incidence Ratio (SIR) for all cancer was 124 (95% confidence interval [CI] 91-165). There were 23 deaths reported for all cancers (Standardized Mortality Ratio [SMR] 87, 95% CI 55-131). Only laryngeal cancer incidence was statistically significant (Standardized Incidence Ratio [SIR] 417, 95% CI 135-972). After review of the work history records, this association was found to be inconsistent with a common exposure hazard at the plant.

Adult↗
PubMed1997

A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction.

BACKGROUND: State-based peer review organizations (PROs) and individual hospitals are challenged to achieve their quality improvement (QI) goals with shrinking resources. In 1993-1994 the Connecticut PRO and 15 local hospitals generated a comparative QI database on acute myocardial infarction (AMI) care for 1,202 Medicare and non-Medicare patients discharged in 1992 and 1993. METHODS: A steering committee composed of hospital and PRO representatives was assembled to provide oversight. PRO staff developed a chart abstraction tool and trained hospital abstracters who collected and submitted data to the PRO for comparative analyses. Written feedback was provided to all hospitals and supplemented with onsite presentations when requested. Each hospital prepared a written QI plan based on its unique data profile. RESULTS: Opportunities for improvement were identified at all hospitals. The most commonly targeted areas for improvement included the use of thrombolytics at presentation, aspirin at presentation and at discharge, and beta blockers at discharge. Improvement interventions included staff education sessions, development of AMI critical paths and standing orders, and storage of appropriate medications in emergency departments. Self-report data from the hospitals indicate improvements in care. DISCUSSION: PROs and hospitals can augment their individual QI activities by working together to share data, resources, and lessons learned. Twenty-three hospitals are now collaborating with the Connecticut PRO on a similarly designed QI project aimed at improving the care of patients hospitalized with atrial fibrillation. This project includes a more formal means of communicating QI interventions.

Aged↗
PubMed1997

What do physicians know about cryptosporidiosis? A survey of Connecticut physicians.

BACKGROUND: Cryptosporidiosis, an intestinal parasitic infection, has gained considerable media attention since a 1993 waterborne outbreak in Milwaukee, Wis, in which more than 400,000 persons became ill. However, the incidence of and risk factors for human cryptosporidiosis in the general US population are unknown. It has been suggested, but not documented, that physicians are generally unaware of the need to specifically request testing for this organism. OBJECTIVE: To assess physician awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts. METHODS: A self-administered questionnaire was mailed to a stratified random sample of Connecticut physicians. Specialties were limited to physicians in internal medicine, gastroenterology, infectious disease, pediatrics, and family or general practice. Responses were compared among specialties. RESULTS: While most physicians were aware that cryptosporidiosis causes watery diarrhea (range, 67%-98%), particularly in patients with acquired immunodeficiency syndrome (> 85% of all specialties), many did not know the symptoms or failed to identify other groups at increased risk. More than 75% of gastroenterologists, general or family practitioners, internists, and pediatricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidiosis. More than 30% of physicians assumed Cryptosporidium testing was included in a standard ova and parasite examination. CONCLUSIONS: Cryptosporidiosis is likely to be unrecognized and underdiagnosed in Connecticut. This may occur because many physicians are unaware of cryptosporidiosis, unsure of the symptoms, do not test for it, or do not order the appropriate test. Unless there is more widespread use of specific tests, it will be difficult to evaluate specific preventive initiatives to limit the overall health impact of cryptosporidiosis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Alcohol and drug abuse among Connecticut youth: implications for adolescent medicine and public health.

In 1995, a statewide survey of alcohol and other drug use was conducted in a random sample of approximately 4,000 7th to 12th graders in public schools in Connecticut. The survey, part of a statewide substance abuse treatment needs assessment, showed that use of tobacco, alcohol, and marijuana was widespread and increasing, particularly among younger students. Connecticut's students reported higher rates of substance use compared to their peers nationwide. Substance use differed according to age, gender, ethnic background, and community type. It was estimated that almost 1-in-10 senior high school students should receive a diagnostic evaluation for substance abuse, with half likely to need a treatment referral. Most of these adolescents had not received treatment for their substance abuse. Primary-care physicians can play a key role in reducing adolescent substance abuse through prevention messages, screening for drug use, brief interventions, and timely referrals to appropriate intervention services.

Adolescent↗
PubMed1998

Connecticut State Special Olympics: observations and recommendations.

The Connecticut State Special Olympics provides an opportunity for thousands of developmentally challenged children and adults to participate in athletic events. This paper retrospectively reviews the demographics and documentation of medical problems in 1994, 1995, and 1996 Summer Games. The 1994 and 1995 summer games took place at the Coast Guard Academy and Connecticut College in New London. The 1996 summer games occurred at Fairfield and Sacred Heart Universities in Fairfield. The mean age of the participants ranged from 30 to 32 years of age. Minor trauma made up the largest percentage of encounters. Most of these injuries were sprains or strains to the lower extremities. The more serious injuries included dislocations and fractures. The incidence of seizure remained stable over these years. A comparison of the 1994, 1995, and 1996 games revealed a nearly 600 fold increase in heat-related dehydration in Fairfield as compared to the 1994 and 1995 games in New London. The highest incidence of sunburn occurred in 1995 despite the availability of sunblock. A concerted effort to reduce sunburn in the 1996 games in Fairfield resulted in a marked decrease of sunburn despite the higher temperatures, but an increase in chemical irritation to the eyes. Recommendations are presented to decrease the incidence of medical problems.

Adult↗
PubMed1998

Pre-discharge outcomes of 22-27 weeks gestational age infants born at tertiary care centers in Connecticut implications for perinatal management.

There is a lack of regional data on survival and morbidity of extremely premature infants born and resuscitated at tertiary care centers. This study analyzes such data from three tertiary care perinatal centers in Connecticut and provides a paradigm for its use in developing guidelines for evidence-based ethical considerations in infants at the threshold of viability. Outcomes of inborn infants 22 to 27 weeks gestation (based on obstetric estimates) who were actively resuscitated at three regional perinatal tertiary-care centers (representing 80% of such infants from Connecticut) were studied retrospectively. Survival and cumulative major morbidities at discharge, stratified by gestational age, were analyzed. Of the 405 infants studied, 278 (69%) survived to discharge. There were no survivors beyond three days at 22 weeks gestational age. Unfavorable outcome defined as death or major morbidity (> or = grade 2 intraventricular hemorrhage, periventricular leukomalacia, > or = Stage 3 retinopathy of prematurity, necrotizing enterocolitis > or = Stage 2, and severe bronchopulmonary dysplasia at 36 weeks postmenstrual age.) was seen in > 85% of 23 and 24 weeks gestation infants. At 25 weeks approximately equal to 30% of infants were discharged without an unfavorable outcome. At 26 and 27 weeks gestation 43% and 61% respectively escaped unfavorable outcomes with > 85% rates of survival. Current regional data such as these would help in developing guidelines for the perinatal management of premature infants at the threshold of viability.

Chi-Square Distribution↗
PubMed1998

Cigarette smoking in Connecticut: home and workplace exposure.

Estimates of smoking prevalence, environmental tobacco smoke exposure patterns, and the effect of sociodemographic variables were obtained from a telephone survey of 596 randomly selected adults in Connecticut, aged 18 or older. Results of this study indicate that 21.5% of respondents smoked cigarettes, and the smoking prevalence of men was almost twice the rate of women. Smokers were disproportionately represented in lower education, income, and occupational status categories. Approximately 60% of respondents stated they do not allow smoking in their homes. Environmental tobacco smoke exposure in the home was inversely related to age, (OR = .12, P < .01) and education (OR = .23, P < .05). Persons employed in crafts, trades, or general labor occupations were three times (P = .01) more likely to work in places which allowed smoking. Although Connecticut ranks among the top 10 states with the lowest cigarette smoking prevalence rates, continued antismoking efforts targeting lower socioeconomic groups will likely further reduce smoking and environmental tobacco smoke among adults and children.

Adolescent↗
PubMed1984

Population structure in the Connecticut Valley. I. Marital migration.

This study reports on an analysis of marital migration among 12 communities in the Connecticut River Valley of Massachusetts during the years 1790-1849. Genetic inferences are drawn, and the requisite assumptions considered. The effect of geographic distance on genetic kinship is predicted using Malécot's isolation-by-distance model. The resulting estimates are discussed in terms of geographic and historical factors. The configuration of communities as predicted by kinship values approximates closely their actual geographic locations. Estimated genetic heterogeneity was low for the historical Connecticut Valley population, and community isolation breaks down rapidly over time. The region thus assumes its place among a number of sedentary, agricultural populations for which the isolation-by-distance model provides an adequate representation. A regression analysis which includes variables in addition to distance indicates that historical and economic factors contribute some additional explanatory power to the distribution of mating frequencies.

Demography↗
PubMed1998

Bird Use of Restoration and Reference Marshes Within the Barn Island Wildlife Management Area, Stonington, Connecticut, USA

/ Tidal marshes have been actively restored in Connecticut for nearly 20 years, but evaluations of these projects are typically based solely on observations of vegetation change. A formerly impounded valley marsh at the Barn Island Wildlife Management Area is a notable exception; previous research at this site has also included assessments of primary productivity, macroinvertebrates, and use by fishes. To determine the effects of marsh restoration on higher trophic levels, we monitored bird use at five sites within the Barn Island complex, including both restoration and reference marshes. Use by summer bird populations within fixed plots was monitored over two years at all sites. Our principal focus was Impoundment One, a previously impounded valley marsh reopened to full tidal exchange in 1982. This restoration site supported a greater abundance of wetland birds than our other sites, indicating that it is at least equivalent to reference marshes within the same system for this ecological function. Moreover, the species richness of birds and their frequency of occurrence at Impoundment One was greater than at 11 other estuarine marshes in southeastern Connecticut surveyed in a related investigation. A second marsh, under restoration for approximately ten years, appears to be developing in a similar fashion. These results complement previous studies on vegetation, macroinvertebrates, and fish use in this system to show that, over time, the reintroduction of tidal flooding can effectively restore important ecological functions to previously impounded tidal marshes.KEY WORDS: Estuarine; Tidal marsh; Wetland birds; Restoration

Journal Article↗
PubMed2005

Populations of a Connecticut River midge structured by geological history and downstream gene flow.

Connecticut River midges in the genus Axarus are constrained to semi-isolated populations associated with submerged clay exposures, and gene flow between populations is restricted. I sampled larval midges from fifteen spatially separated sites in the Connecticut River and determined karyotypes for 3111 larvae in two closely related species. In one of these species, an undescribed species referred to as Axarus species varvestris, 5 chromosomal rearrangements were present as polymorphisms. Four of these are paracentric inversions, and the fifth is a terminal insertion or deletion. I used chromosomal rearrangement frequencies to calculate Nei's genetic distance measures for all pairwise population comparisons and I constructed a neighbor-joining phenetic tree for the populations using these distances. Genetic distance between populations of A. sp. varvestris increases with geographic separation, and tree structure indicates that restricted gene flow only occurs in a downstream direction. The effect of unidirectional (downstream) gene flow on population genetic structure in riverine midges is described here for the first time. A genetic break is apparent between populations associated with 12 000-year-old sediments originating in different ancient lakes. The geological break between lakes also coincides with a break in the species composition of the Axarus populations.

Animals↗
PubMed1978

Productivity of ospreys in Connecticut--Long Island increases as DDE residues decline.

Nesting success of ospreys (Pandion haliaetus) breeding in the Connecticut--Long Island area has increased since 1973 and is now approaching the levels recorded prior to the 1950's. Simultaneously, DDE and dieldrin residues have declined in unhatched eggs. Levels of polychorinated biphenyls have shown no changes over the period 1969 to 1976. The increase in productivity is attributed primarily to lower levels of DDE contamination. Detrimental effects in the past on ospreys in the Connecticut River estuary are attributed to local contamination with dieldrin.

Animals↗
PubMed1983

Spirochetes in Ixodes dammini and mammals from Connecticut.

Spirochetes were observed in the midguts of 35% of 147 motile Ixodes dammini from three locations in Lyme and East Haddam, Connecticut. Positive ticks were removed from eastern chipmunks (Tamias striatus), raccoons (Procyon lotor), white-footed mice (Peromyscus leucopus), and a red squirrel (Tamiasciurus hudsonicus). Spirochetes were isolated in fortified Kelly's medium from nine questing or partially engorged I. dammini adults and nymphs and from the bloods of a raccoon and a white-footed mouse. Connecticut isolates from ticks and mammals were serologically indistinguishable from the original Shelter Island, New York strain when cross-tested by immunofluorescence against their mouse antisera. Sera from eight patients diagnosed as having Lyme disease contained antibodies to spirochetes isolated from ticks and mammals. Our finding of serologically and morphologically indistinguishable spirochetes in a raccoon, white-footed mouse and ticks suggests that closely related serotypes are present in wild mammals commonly parasitized by I. dammini, and further supports the claim that a spirochete is involved in the etiology of Lyme disease.

Animals↗