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PubMed1992

Stomach cancer patterns in European immigrants to Connecticut, United States.

Age-adjusted annual incidence rates of stomach cancer (ICD-9 code #151) were examined for the period 1973-88 among Connecticut residents who were born in the United States or who emigrated from one of five European nations (Italy, Poland, the United Kingdom, Germany, Portugal). Risk of stomach cancer among each of the five immigrant groups was elevated significantly above that of US-born residents. The magnitude of difference ranged from a 1.62-fold excess among persons born in Italy to a 4.27-fold increase in risk among persons born in Portugal. Cancer risk to foreign-born residents was less than that observed in their native countries, with decreases of 25-64 percent found here. Several differences in patient and disease characteristics were observed according to country of birth. Compared with US-born residents, there was a lesser predominance of males among patients born in Italy, Poland, and the UK. Among all foreign-born groups, the gastric cardia was involved less frequently, and the pyloric region more frequently, than in US-born patients. Adenocarcinomas were significantly less common among Polish-born cases. The findings suggest different etiologies in foreign and US-born patients.

Adolescent↗
PubMed1992

Patterns of metal accumulation in Laminaria longicruris from Long Island Sound (Connecticut).

Laminaria longicruris de la Pyl. samples were harvested from Long Island Sound (Connecticut) from January 1985 to January 1986. Cadmium and copper content was determined by atomic absorption spectrophotometry from four tissue types; young blade, old blade, young stipe and old stipe. The results were statistically analyzed for differences in both type and age of tissue. Concentrations of cadmium were consistently lower than copper concentrations for all months and all tissue types. Statistically significant differences (p greater than 0.05) were found between the four tissue types for copper in the months of March, June, July, October and December, and for cadmium in the months of February, March, June, July, October and November. Young blade tissue and young stipe tissue were the tissues which most frequently found to be statistically different from the other tissues. Young stipe tissue had the lowest trace metal concentrations (1.3 mean ppm, dry wt. Cu, 0.22 mean ppm, dry wt. Cd). Young blade tissue had significantly higher metal values in comparison to the other tissues for the months of June and October. Old tissue of L. longicruris is the most suitable for use in biomonitoring of trace metals due to the relatively little variation in metal content that was found throughout the study period.

Cadmium↗
PubMed1977

Changes in site distribution of colorectal carcinoma in Connecticut, 1940-1973.

The proportion of colorectal cancer occurring above the rectosigmoid junction has been increasing over time. The 40,771 cases of colorectal carcinoma reported to the Connecticut Tumor Registry from 1940 through 1973 were analyzed to determine the incidence in the ascending colon, the transverse, descending, and sigmoid colon, and the rectum. The numbers of cases, the proportion, and incidence rates of cancer in the ascending colon and sigmoid have increased over the 34 years. The increases were greatest among people over 65 years old. Only about half of colorectal cancer can now be identified with the rigid sigmoidoscope. Other tests must be used for early diagnosis of the increased numbers of cancers in the upper parts of the colon.

Adolescent↗
PubMed1996

Outcome analysis of carotid endarterectomy in Connecticut: the impact of volume and specialty.

The purpose of this study was to define the relationship between the surgeon's operative experience and specialty and the postoperative morbidity and mortality of carotid endarterectomy. All patients undergoing carotid endarterectomy (code ICD-9CM 38.12) in Connecticut between October 1985 and September 1991 were retrospectively identified. A total of 3997 carotid endarterectomies were performed by 226 surgeons in four specialties: general, cardiac, vascular, and neurosurgery. Individual surgeon volume ranged from fewer than one per year to 27.5 per year (mean 2.9 carotid endarterectomies per year). Outcome was measured as a combined stroke and/or death percentage. The average combined stroke and/or death rate for the entire group was 4.9%. The combined stroke and/or death percentage was influenced significantly by the surgeon's annual volume. Surgeons who performed one or fewer carotid endarterectomies (43% of total surgeons) were 2.5 times more likely (p < 0.002) to have a poor postoperative outcome than those who performed 10 or more per year (9.3% of total surgeons). Overall there was a statistically significant correlation between a surgeon's annual volume and outcome, particularly for general surgeons.

Clinical Competence↗
PubMedDate not supplied

Predictors of breast-conserving surgery in Connecticut, 1990-1992.

BACKGROUND: Breast-conserving surgery (BCS) has been recommended for most early-stage primary breast cancers, but predictors may vary by time and geographic area. METHODS: Among 5,266 early-stage female breast cancers (diagnosed in 1990-1992) in the population-based Connecticut Tumor Registry, the poverty rate of census tract of residence (an ecologic indicator of socioeconomic status), age at diagnosis, race, marital status, extent of disease, year of diagnosis, and town of residence were analyzed in relation to BCS use. RESULTS: The poverty rate of census tract was not a statistically significant variable in logistic regression analyses of BCS use; however, age, year of diagnosis, and stage at diagnosis were predictors. Residence in a town with a hospital having radiotherapy facilities or near a university hospital were not predictors of BCS use. High BCS rates (69-94% vs. 49% statewide) were found for residents of a cluster of seven contiguous towns associated with a single (nonuniversity) hospital. CONCLUSIONS: BCS was not associated with poverty level of area of residence but continued to be lower for larger or node-positive cancers. Attitudes and practices of local physicians were hypothesized as being important in explaining variation in BCS use by town of residence.

Breast Neoplasms↗
PubMed1998

Mortality in Hartford, Connecticut: a comparison with the South Bronx, New York.

Very high mortality rates have been reported in large inner-city areas such as the South Bronx and Harlem in New York City, but also may occur in smaller US urban areas. Using published death rates for the South Bronx as the standard, the standardized mortality ratio was slightly lower than 1.00 for Hartford, Connecticut (population 139,739 in 1990), but more than 1.00 for three impoverished Hartford census tracts that contained public housing projects. Compared with the South Bronx, death rates in Hartford were lower for human immunodeficiency virus (HIV), injury-homicide, and alcohol-drugs, but higher for hypertension-stroke (in all three tracts) and cancer (in two of the three tracts). Variations in patterns of causes of death among impoverished US urban areas have implications for planning epidemiologic studies and targeting interventions.

Adult↗
PubMed2006

Factors associated with receiving help and risk factors for disaster-related distress among Connecticut adults 5-15 months after the September 11th terrorist incidents.

BACKGROUND: To obtain prevalence estimates and identify factors associated with psychological problems and receipt of help by a geographically proximate population in which some persons had direct exposure but the overall prevalence of direct exposure was low, 5-15 months after the September 11th, 2001 terrorist incidents. METHOD: Telephone survey data from the Behavioral Risk Factor Surveillance System (BRFSS) (Connecticut Module) with a randomly selected cohort of 2741 women and 1899 men aged 18 and older were examined using bivariate Chi Square and multivariate logistic regression analyses of weighted data. RESULTS: One in three respondents reported 9/11-related psychological problems, 26% of whom reported receiving formal services or peer support. Risk factors for reporting psychological problems included being surveyed earlier, female gender, age 64 or younger, Hispanic ethnicity, disability, recent depression, and reporting one day or more in the past 30 of poor mental health, sleep problems or worry. Poor mental health was associated with receipt of formal services, and increased alcohol use was associated with receipt of peer support. CONCLUSION: In the post-impact recovery period following mass trauma, psychological problems by persons with ongoing mental health conditions or increased alcohol use warrant continuing public and professional attention. Women, Hispanics, and disabled adults also may be under-served.

Adolescent↗
PubMed2006

Polymorphisms in DNA repair genes and risk of non-Hodgkin lymphoma among women in Connecticut.

Several hereditary syndromes characterized by defective DNA repair are associated with high risk of non-Hodgkin lymphoma (NHL). To explore whether common polymorphisms in DNA repair genes affect risk of NHL in the general population, we evaluated the association between single nucleotide polymorphisms (SNPs) in DNA repair genes and risk of NHL in a population-based case-control study among women in Connecticut. A total of 518 NHL cases and 597 controls recruited into the study provided a biologic sample. Thirty-two SNPs in 18 genes involved in several DNA repair pathways were genotyped. Genotype data were analyzed by unconditional logistic regression adjusting for age and race. SNPs in four genes (ERCC5, ERCC2, WRN, and BRCA1) were associated with altered risk of NHL and diffuse large B-cell lymphoma (DLBCL), the major B cell subtype. In particular, ERCC5 Asp1104His was associated with increased risk of NHL overall (OR: 1.46; 95% CI: 1.13-1.88; P=0.004), DLBCL (OR: 1.44; 95% CI: 0.99-2.09; P=0.058), and also T cell lymphoma. WRN Cys1367Arg was associated with decreased risk of NHL overall (OR: 0.71; 95% CI: 0.56-0.91; P=0.007) and DLBCL (OR: 0.66; 95% CI: 0.45-0.95; P=0.024), as well as follicular and marginal zone lymphomas. Genetic polymorphisms in DNA repair genes, particularly ERCC5 and WRN, may play a role in the pathogenesis of NHL, especially for DLBCL. Further work is needed to extend these findings by carrying out extended haplotype analyses of these and related genes and to replicate the observations in other studies.

Adult↗
PubMed2006

Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut.

Nearly 100 years ago, Afzelius described a patient with an expanding skin lesion, called erythema migrans, which is now known to be the initial skin manifestation of Lyme borreliosis. Approximately 70 years later, in 1976, epidemiologic evaluation of a cluster of children with arthritis in Lyme, Connecticut led to a complete description of the infection. During the subsequent years, investigators in a number of countries have made remarkable strides in the elucidation of this tick-borne spirochetal infection. The purpose of this review is to discuss the current status of Lyme borreliosis, including areas in which knowledge of the infection is still incomplete.

Adult↗
PubMed2006

Assessing the impact of screening mammography: Breast cancer incidence and mortality rates in Connecticut (1943-2002).

BACKGROUND: Randomized controlled studies demonstrate that early detection and intervention reduce breast cancer mortality by approximately 25%. Though the ultimate goal of screening is to reduce breast cancer deaths, the immediate goal is to detect and treat early-stage tumors before they pose a threat to life. MATERIALS AND METHODS: To assess the impact of early detection and intervention in the general population, we analyzed breast cancer incidence and mortality rates in the NCI's Historical Connecticut Tumor Registry (1943-2002). RESULTS: Though breast cancer rates increased for the entire study period, overall incidence rates rose faster than previously following the initiation of mammography screening in the early 1980s in the United States. Of note, stage-specific incidence rates increased 152% (53.2-133.9 per 100,000 woman-years) for early-stage tumors and fell 16% (56.1-47.2 per 100,000 woman-years) for late-stage breast cancers. Period- and cohort-age-specific incidence rates rose dramatically for early-stage tumors among women targeted for screening (ages 40-80 years), whereas rates for regional and distant stages declined modestly among women ages >50 years. Breast cancer mortality rates fell 31.6%. CONCLUSIONS: Along with increases in incidence rates for early-stage tumors, rates for late-stage disease and breast cancer mortality declined following widespread screening mammography, consistent with effective early detection and improved treatment over time. However, the disparity between the dramatic rise in early-stage tumors compared to the more modest declines in late-stage disease and mortality suggests that many mammography-derived early-stage lesions may never progress to late-stage cancers and pose a threat to life.

Adult↗
PubMed1989

Population screening for plasma cholesterol: community-based results from Connecticut.

Plasma cholesterol levels were measured in 15,892 participants of a cholesterol screening in Hartford, Connecticut. The screenees were typically health conscious as evidenced by the low prevalence of current cigarette smoking (12%). However, more than 25% of the men and 35% of the women over the age of 50 years had cholesterol levels in excess of 240 mg/dl, placing them at moderate to high risk for coronary artery disease. Results showed a pronounced dose-response relationship between cigarette smoking and cholesterol levels in men of all age groups and in women of premenopausal age; however, average cholesterol levels were similar in exsmokers and subjects who had never smoked. Risk analysis revealed a strong positive association between cholesterol and prevalence of nonfatal myocardial infarctions. Notably patients with newly diagnosed hypercholesterolemia reduced their cholesterol levels an average of 40 mg/dl under the care of a physician. These results indicate that cholesterol screening coupled with physician follow-up and treatment can have a substantial impact in lowering cholesterol levels and the attendant risk of cardiovascular disease.

Adolescent↗
PubMed1993

Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut.

PURPOSE: To report on the deployment of the syringe tracking and testing system in the New Haven needle exchange program, which is the first federally funded evaluation of a needle exchange program conducted in the United States. PATIENTS AND METHODS: A legal needle exchange for intravenous drug users began in New Haven, Connecticut, in November 1990. All syringes distributed by the program received unique tracking codes. Syringes were tracked and HIV-1 proviral DNA prevalence in returned syringes was assessed using polymerase chain reaction and Southern blotting. RESULTS: At the outset of the program, the prevalence of HIV-1 proviral DNA in syringes exceeded two thirds. Prevalence decreased rapidly to less than 45% during the first 3 months of the program and remained at this level for the following 10 months. During the periods of decreasing prevalence and subsequent steady state, no changes in the demographics of program participants or in the drug use habits of newly enrolling clients that could account for the decrease in HIV-1 prevalence in needles were detected. In addition, the program referred almost 20% of its clients to drug treatment programs. CONCLUSION: The needle exchange program in New Haven has decreased the percentage of syringes testing positive for HIV-1 proviral DNA among needle exchange clients while simultaneously serving as an entry point for drug treatment.

Analysis of Variance↗
PubMed1982

Suicide rates among cancer patients in Connecticut.

This study derives age-sex specific standardized mortality ratios (SMR's) among cancer (ca) patients with respect to population suicide rates. Suicide rates were derived for all 144,530 ca patients in the Connecticut Tumor Registry from 1940-1973. We also derived rates by number of years since diagnosis (y-s-dx) and by decade of dx. We hypothesized beforehand that suicide rates will (1) be higher in ca patients than the population; (2) be higher soon after dx than in later y-s-dx; (3) vary directly with spread of disease at dx, highest for metastatic, lowest for local. We address hypotheses (1) and (2) here. After collapsing age groups and y-s-dx in the observed 192 ca patient suicides, SMR's derived for age, sex and y-s-dx were tested with an exact Poisson distribution. Overall, SMR for males was significantly elevated (230, P less than 0.005), but not for females. In males, a test for trend in SMR's with y-s-dx showed a significant decline, supporting hypothesis (2) for males (chi2 = 4.0, df = 1, P less than 0.05). No trend was found for decade of dx. On combining decades, male SMR's were significantly elevated in 10 of the 25 cells of age by y-s-dx, while none of the female cells was significant. We conclude that both hypotheses were supported for males, and neither for females.

Adolescent↗
PubMed1983

The prevalence distribution of hypertension: Connecticut adults 1978-1979.

The results of the first Connecticut Blood Pressure Survey are reported. It was found that sharp differences exist in the prevalence of hypertension by age and sex but that race differences are much less than previously reported for United States populations. Differences were also found between men and women with respect to the patterns of treatment and control. Age differences in treatment and control are noted. The findings reported are based on a statewide probability sample for which the target population exceeded 2 million persons. Because of the complexity of sampling such a population an extensive discussion of the survey method is given.

Black or African American↗
PubMed1987

Factors associated with the risk of second primary breast cancer: an analysis of data from the Connecticut Tumor Registry.

To examine further the epidemiology of contralateral primary breast cancer, a case-control analysis, utilizing information available from the Connecticut Tumor Registry, was conducted. Recent cases of second primary breast cancer were compared to control women who had survived a first breast cancer but had not developed a second. Three hundred and thirty eight incident cases of contralateral breast cancer diagnosed between 1979 and 1982 were identified and compared with an equal number of randomly selected controls and 336 controls frequency matched to the cases on the basis of age at initial cancer diagnosis and the calendar time elapsing since that diagnosis. Risk of second primary breast cancer was found to be significantly elevated among women whose initial cancer was lobular carcinoma and during the first year following diagnosis of the initial primary. Additionally, for women initially treated with radiotherapy, risk of a contralateral primary increased for 10-14 years following treatment, after which it declined. Among young women, having never married was protective whereas the opposite was found among older women. These findings and the methods used are discussed in the context of the epidemiology of both contralateral and initial breast primaries.

Adult↗
PubMed1989

Survival of children diagnosed with acute lymphoblastic leukemia in 1977-82 in Connecticut.

There was no evidence for an increase in survival among all all cases (N = 104) diagnosed between 1977-82 with acute lymphoblastic leukemia (ALL) at age less than 15 years and reported to the population-based Connecticut Tumor Registry (CTR). Hazard rates were consistently higher in males vs females during the second year after diagnosis, especially in males diagnosed after 1977-78. Registry data on prognostic factors, including white blood cell (WBC) count at diagnosis and Down's syndrome (DS), and initial treatment were used to interpret survival data by sex and year of diagnosis. A statistically significant sex difference in 4-year survival among cases diagnosed in 1979-80 was related to an unusually high survival rate (i.e. 100%) in females and the occurrence of two male DS cases. Further studies are needed on sex-specific survival rates among ALL cases diagnosed after 1977-78 in population-based cancer registries, which could be improved by more complete collection of data on immunophenotype and validation of data on relapses.

Child↗
PubMed2004

Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer control.

The purpose of this study was to examine the geographic distribution of standardized incidence ratios (SIRs) for Connecticut's 169 towns for 18,382 cancers diagnosed in 1995-2000 at sites most strongly associated with tobacco and/or alcohol (i.e, lung, oral cavity-pharynx, and esophagus), with consideration of census-derived indicators of socioeconomic status (SES) at the town level. For males, the state's four largest towns, all in the highest poverty-rate quartile, had statistically significantly elevated SIRs for both lung cancer and oral cavity-pharynx cancers, and also had elevated SIRs for esophageal cancer. Two of these four towns also had statistically significantly elevated SIRs for oral cavity-pharynx cancer for females. SIRs for both males and females were lowest for the lowest poverty quartile and highest for the highest poverty quartile, for each cancer-site group. Among 15,271 patients diagnosed with their first cancer at any of the selected sites in 1995-2000, risk of diagnosis of a second primary cancer at any of these sites (139 patients) was highest in the highest poverty-rate quartile. These surveillance methods should be useful for targeting cancer control efforts aimed at prevention or cessation of tobacco and/or heavy alcohol use, and early detection or chemoprevention of these cancers, including second primary cancers.

Adolescent↗
PubMed2006

The effects of the checkpoints program on parent-imposed driving limits and crash outcomes among Connecticut novice teen drivers at 6-months post-licensure.

INTRODUCTION: Because crash rates are highly elevated during the first months of licensure, it is advisable for parents to limit teen driving so that teens can gain independent driving experience under less dangerous driving conditions. This report describes the effect of the Checkpoints Program on parent limits on novice teen driving through six months post-licensure. METHODS: Nearly one-quarter of all Connecticut teens who obtained a learner's permit over a 9-month period were recruited, providing a final sample of 3,743 who obtained licenses within the next 16 months. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while on the same schedule comparison families received standard information on driver safety. RESULTS: Families who participated in the Checkpoints Program reported significantly greater limits on teen driving at licensure, 3-months, and 6-months post-licensure. However, there were no differences in reported risky driving behavior, violations, or crashes. CONCLUSION: This is the first statewide study testing the efficacy of the Checkpoints Program. The results indicate that it is possible to foster modest increases in parental restrictions on teen driving limits during the first six months of licensure using passive persuasive communications, but that the levels of restriction obtained were not sufficient to protect against violations and crashes.

Adolescent↗