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PubMed2005

Assessing the role of long-distance translocation and spatial heterogeneity in the raccoon rabies epidemic in Connecticut.

Spatial heterogeneity and long-distance translocation (LDT) play important roles in the spatio-temporal dynamics and management of emerging infectious diseases and invasive species. We assessed the influence of LDT events on the invasive spread of raccoon rabies through Connecticut. We identified several putative LDT events, and developed a network-model to evaluate whether they became new foci for epidemic spread. LDT was fairly common, but many of the LDTs were isolated events that did not spread. Two putative LDT events did appear to become nascent foci that affected the epidemic in surrounding townships. In evaluating the role of LDT, we simultaneously revisited the problem of spatial heterogeneity. The spread of raccoon rabies is associated with forest cover--rabies moves up to three-times slower through the most heavily forested townships compared with those with less forestation. Forestation also modified the effect of rivers. In the best overall model, rabies did not cross the river separating townships that were heavily forested, and the spread slowed substantially between townships that were lightly forested. Our results suggest that spatial heterogeneity can be used to enhance the effects of rabies control by focusing vaccine bait distribution along rivers in lightly forested areas. LDT events are a concern, but this analysis suggests that at a local scale they can be isolated and managed.

Animals↗

PubMed2003

Factors influencing injury severity of motor vehicle-crossing pedestrian crashes in rural Connecticut.

The ordered probit model was used to evaluate the effect of roadway and area type features on injury severity of pedestrian crashes in rural Connecticut. Injury severity was coded on the KABCO scale and crashes were limited to those in which the pedestrians were attempting to cross two-lane highways that were controlled by neither stop signs nor traffic signals. Variables that significantly influenced pedestrian injury severity were clear roadway width (the distance across the road including lane widths and shoulders, but excluding the area occupied by on-street parking), vehicle type, driver alcohol involvement, pedestrian age 65 years or older, and pedestrian alcohol involvement. Seven area types were identified: downtown, compact residential, village, downtown fringe, medium-density commercial, low-density commercial, and low-density residential. Two groups of these area types were found to experience significantly different injury severities. Downtown, compact residential, and medium- and low-density commercial areas generally experienced lower pedestrian injury severity than village, downtown fringe, and low-density residential areas.

Alcohol Drinking↗

PubMed1991

Guidelines for the provision of psychological evaluations for infertile patients at the University of Connecticut Health Center.

OBJECTIVE: Because of the psychologically demanding nature of infertility treatment, it has been recommended that psychological services be made available to infertile patients. However, no specific guidelines for the scope or usage of those services has been proposed. Our objective was to formulate guidelines to be used at our institution to provide psychological evaluations to infertility patients. DESIGN: The guidelines were formulated through discussions between the division psychologist and attendings and then presented to and modified by the University Ethics, Risk Management, Legal, and Institutional Review Board departments. SETTING: The University of Connecticut Health Center Division of Reproductive Endocrinology and Infertility provides tertiary level care to infertility patients. Services include assisted reproductive technologies and donor gamete programs. Surrogate parenting is not a provided service. RESULTS: Guidelines for the provision and use of psychological services for infertility patients were formulated. CONCLUSIONS: These guidelines are preliminary in nature and intended to provide a starting point for discussion among physicians, nurses, and mental health professionals regarding the psychological needs of infertility patients.

Culture↗

PubMed1999

Development of a statewide protocol for the prehospital identification of DNR patients in Connecticut including new DNR regulations.

This article describes the development and implementation of a standardized protocol for the prehospital identification of terminally ill "do-not-resuscitate" (DNR) patients. This pilot program was initiated by members of the Connecticut College of Emergency Physicians and instituted on a voluntary basis statewide in July 1991. Key components of the program are discussed, including developmental rationale, formation of a DNR Coalition, educational rollout, and implementation activities. The second phase of this initiative involved passage of state legislation and development of new DNR regulations, which went into effect in July 1997. The regulations successfully addressed the limitations and difficulties encountered in the pilot program. Major modifications included applicability of the bracelet program to a broader group of DNR patients, development of a uniform system for interfacility transfer of DNR patients, and mandatory compliance by health care personnel.

Connecticut↗

PubMed1998

Factors associated with smoking among children and adolescents in Connecticut.

INTRODUCTION: The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4-6), middle school (grade 7-8), and high school (grades 9-12) students in Connecticut. METHODS: We have used data from 8 years (1988-1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test. RESULTS: Fifteen percent (n = 4,884) of the total population (n = 31, 861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4-6. CONCLUSIONS: Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.

Adolescent↗

PubMed2002

The ketogenic diet: a review of the experience at Connecticut Children's Medical Center.

We undertook a retrospective analysis of epilepsy patients referred and treated for more than 6 months with the ketogenic diet during 1994-1999 at Connecticut Children's Medical Center. Outcome measures included antiepileptic drug number, seizure frequency, electroencephalogram background/paroxysmal activity, and adverse effects at 6 months and 1 year on the ketogenic diet. The final cohort included 24 of 48 referred patients (mean age, 6.5 years; range = 1-15 years of age). The etiology of epilepsy was equally divided between idiopathic and cryptogenic epilepsy and symptomatic epilepsy. Intention to treat analysis revealed that 35% (17 of 48) achieved more than 50% reduction in seizure frequency, and 8.5% (four of 48) were seizure-free by 6 months. A sustained 50% or greater reduction at 1 year was observed in 23% (11 of 48), and the same 8.5% (four of 48) remained seizure-free. None of these improvements were statistically related to age (P = 0.97), sex (P = 0.78), or epilepsy etiology (P = 0.80). The number of antiepileptic drugs used per patient decreased. Electroencephalogram at 1 year demonstrated an improvement in background in 31% (five of 16 patients) and a reduction in paroxysmal features in 37.5% (6 of 16 patients). Most adverse effects were mild, self-limited, and occurred early. Hyperuricemia (more than 6 mg/dL) was more persistent in three patients.

Academic Medical Centers↗

PubMed1997

Time trend of female breast carcinoma in situ by race and histology in Connecticut, USA.

A rapid increase of female breast cancer has been reported in many areas of the world and the reasons are not fully understood. While some have attributed the increase to the increasing detection of early stage breast cancer through mammography screening, few studies have directly examined the time trend of in situ breast cancer specifically. This study included all incident cases of female breast carcinoma in situ reported to the Connecticut Tumor Registry between 1973 and 1992. The age-adjusted incidence rates and age-specific incidence rates were calculated by histology and by race. The age-adjusted incidence rates were standardised to the 1970 United States standard million population. The study found that the overall age-adjusted incidence rate of in situ breast cancer has increased dramatically, from 3.53/100000 in 1973-1975 to 17.51/100000 in 1991-1992. The increase was not uniform during the past two decades of cancer registration. In fact, most of the observed rise has occurred since the early 1980s. This increase was found in both Caucasians and Blacks. The results by histology indicate that the dramatic increase in carcinoma in situ is mostly attributable to an increase in ductal carcinoma in situ. The increase was also observed in all age groups 40 years and over. These results are consistent with the use pattern and the reported effect of mammography screening. Therefore, these results are qualitatively consistent with the idea that mammography screening is largely responsible for the recent upsurge in female breast cancer incidence in this population. The study also found that the age group 40-49 years in whites experienced a rapid increase in incidence that began in the same time period as the older age groups, but it has since levelled off. The potential impact of the highly publicized debate regarding the efficacy of mammography in this age group in recent years is discussed.

Adult↗

PubMed2003

The risk of a contralateral breast cancer among women diagnosed with ductal and lobular breast carcinoma in situ: data from the Connecticut Tumor Registry.

BACKGROUND: Women diagnosed with breast carcinoma in situ are at increased risk for developing a contralateral breast cancer. The magnitude of this risk and the relationship between this risk and age, time since diagnosis, histologic subtype, and treatment for the first breast cancer is continuing to be defined. METHODS: The risk of developing a contralateral breast cancer is examined among 4198 women diagnosed with breast carcinoma in situ and reported to the Connecticut Tumor Registry (CTR) between January 1, 1975 and March 14, 1998 using Kaplan-Meier estimation. A Cox proportional hazards model is used to assess the effect of surgical treatment, radiation therapy, age at diagnosis, race, histology, marital status, anatomic location within the breast, and time since diagnosis upon this risk. RESULTS: The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a ductal breast carcinoma in situ (DCIS) were 4.3% (95% confidence interval, 3.6-5.0%) and 6.8% (95% confidence interval, 5.5-8.2%), respectively. These risks are 3.35 times greater than those for women without a history of breast cancer but are similar to those for women diagnosed with non-metastatic invasive ductal carcinomas of the breast. The cumulative 5- and 10-year probabilities of being diagnosed with a contralateral breast cancer among women initially diagnosed with a lobular breast carcinoma in situ (LCIS) were 11.9% (95% confidence interval, 9.5-14.3%) and 13.9% (95% confidence interval, 11.0-16.8%), respectively. CONCLUSIONS: Women diagnosed with LCIS were 2.6 (95% confidence interval, 2.0-3.4%) times more likely than women with DCIS to be diagnosed with a contralateral breast cancer within the first six months of the first breast primary. The risk of developing a contralateral breast cancer more than 6 months after the initial breast cancer was independent of surgical or radiation therapy, time since diagnosis, age at diagnosis, histology, race, marital status, or anatomic location of the cancer within the breast.

Adult↗

PubMed1991

Quality assurance in the Connecticut Helicopter Emergency Medical Service.

Quality Assurance (QA) is a vital aspect of the Connecticut Helicopter Emergency Medical Service (HEMS). The program has three components: 1. scene flight audit, 2. random chart audit, and 3. biweekly patient care QA conferences. The scene flight audit identifies patients who, in retrospect, may not have required helicopter transportation. These patients are identified by the following criteria: trauma score greater than 12 and injury severity score less than 16, emergency department deaths, discharged within 24 hours, medical patients. Patient care QA involves review of all flights. A random chart audit is a method of peer review of the written flight record for completeness. The scene flight audit was from 6/85 to 12/87, with 17/107 (16%) in group one, 0/137 (0%) in group two, 5/29 (17%) in group three, and 8/54 (15%) in group four not justified. There were four audit review periods, each with a feedback mechanism to share results with providers. Each audit resulted in a decrease in the number of non-justified flights. There were 57 patient care QA conferences with 231 cases presented. Technical errors and policy issues decreased over time. Random review of five charts/month were reported quarterly. Omitted elements of standard documentation decreased over time. QA can be accomplished in HEMS. Monitored areas should include appropriateness of flights, proper documentation, and patient care review. A QA program improves appropriateness of flights, medical record keeping, and care given.

Aircraft↗

PubMed2001

Assessing the quality of asthma care provided to Medicaid patients enrolled in managed care organizations in Connecticut.

BACKGROUND: Many states have enrolled Medicaid beneficiaries in managed care organizations (MCOs). Few assessments of the quality of asthma care provided by these new programs are available. OBJECTIVE: To describe the quality of care provided to asthmatic Medicaid children enrolled in MCOs. METHODS: For this cross-sectional survey, a chart abstraction tool was developed to evaluate fulfillment of key performance measures chosen from a national guideline for asthma diagnosis and management. These measures were prescription of an inhaled anti-inflammatory medication, accomplishment of patient education, evaluation of exposure to environmental triggers of asthma, and administration of influenza vaccination. From State of Connecticut administrative databases, a random sampling of Medicaid children, ages 5 to 18 years, enrolled in four MCOs was selected. Chart entries from July 1, 1996 to June 30, 1997 were reviewed using the abstraction tool. Accomplishment of performance measures was evaluated for the total sample and for children who were high utilizers of medical services (at least one ED visit or hospitalization during the study period). RESULTS: For 80 high utilizers among 315 children, completion of performance measures was suboptimal: 46% were prescribed inhaled steroids; an action plan was outlined for 43%; evaluation of patient or family tobacco use was documented for 56%; evaluation of the presence of a pet for 43% or mite exposure for 19%; and allergy skin testing or RAST was accomplished for 15%. CONCLUSIONS: This information suggests that opportunities exist to improve the quality of care for these children.

Adolescent↗

PubMed1999

Melanoma incidence in Connecticut by town of residence.

In an analysis of 2,935 cases of invasive melanoma of the skin diagnosed among residents of Connecticut's 169 towns in 1990-1994, 12 of the 17 towns with statistically significantly elevated standardized incidence ratios (SIRs) were on or near the ocean shoreline (in the extreme southern part of the State). The distribution of melanoma thickness did not support the hypothesis of greater detection of clinically less significant cancers in the ocean shoreline area with high SIRs. In multiple regression analyses, town location (on the ocean shoreline) was a statistically significant predictor of SIR by town, independent of socioeconomic indicators and racial composition. Although the effects of shoreline residence and latitude were difficult to separate, the results should be useful in planning analytic epidemiologic (i.e. case-control) studies in specific geographic areas for testing etiologic hypothesis as a basis for planning public health interventions.

Connecticut↗

PubMed1999

Trends in the incidence of lip, oral, and pharyngeal cancer: Connecticut, 1935-94.

Using Connecticut Tumor Registry data we explored trends in age-adjusted (AARs) and age-specific (ASRs) incidence rates for lip, oral, and pharyngeal cancer over the 60-year period 1935-94. Particular attention was given to findings from the most recent series of 5-year periods that have not been previously analyzed. There was a long-term decline in lip cancer AARs by period, and ASRs generally fell over time and with successive birth cohorts. This notable decrease in rates continued through 1990-94 and with the more recent cohorts, particularly among males. Oral cancer AARs for males peaked in the early 1960s and the late 1970s while rates for pharyngeal cancer increased into the late 1970s. For each of these sites, rates began to decline in 1980-84 and have continued to fall into the first half of the 1990s. Among females AARs for oral and pharyngeal cancer increased more than threefold between 1935-39 and 1980-84; however, encouragingly, and in sharp contrast to the earlier trend, rates fell during the most recent 10-year period. ASRs for oral and pharyngeal cancer were increasing by the birth cohort of 1900 and tended to increase through the cohort of 1920 for males and the cohorts of 1920-30 for females. ASRs for subsequent cohorts have remained relatively unchanged or decreased modestly. It is doubtful that the observed trends in lip, oral and pharyngeal cancer incidence are primarily artifactual, but more likely represent secular changes in exposure to environmental risk factors.

Adolescent↗

PubMedDate not supplied

Influence of the Fight BAC! food safety campaign on an urban Latino population in Connecticut.

OBJECTIVE: To assess the coverage and consumer satisfaction with the Fight BAC! campaign and to evaluate the influence of the campaign on food safety knowledge, attitudes, and behaviors among a predominantly Latino population living in inner-city Hartford, Connecticut. DESIGN: A cross-sectional pre- and post-survey was administered to 500 Latino consumers in either English or Spanish. It included 30 food safety-related questions and information on the socioeconomic and demographic characteristics of participants. SETTING AND PARTICIPANTS: Respondents were selected from Latino households, with at least one child 12 years old or under, located in 5 predominantly Latino neighborhoods in inner-city Hartford. INTERVENTION: Fight BAC! media campaign. RESULTS: Seventy-three percent of respondents were exposed to at least one campaign media item and were highly satisfied with it. Recognition of the Fight BAC! logo increased from 10% to 42% between surveys (P <.001). Individuals exposed to the campaign were more likely to have a food safety knowledge score of at least 2 of a possible 4 compared with unexposed counterparts (odds ratio = 3.54; 95% CI 1.74-7.18; P <.001). They were also more likely to report defrosting meats in the refrigerator (14% vs 7%; P =.01). There was a dose-response association between the degree of campaign exposure and awareness of the term "cross-contamination." CONCLUSION AND IMPLICATIONS: Social marketing campaigns that take advantage of multiple culturally relevant media channels are likely to improve food safety awareness and bring about changes in food safety knowledge and attitudes among Latino consumers.

Adult↗

PubMed2004

Preventing pressure ulcers in Connecticut hospitals by using the plan-do-study-act model of quality improvement.

BACKGROUND: Seventeen hospitals and the Peer Review Organization of Connecticut (Qualidigm) attempted to increase early identification of high-risk patients and utilization of pressure ulcer preventive measures. METHODS: A multihospital retrospective cohort study with medical record abstraction was used to obtain a total of 1,955 (baseline) and 891 (follow-up) patients aged 65 years and older discharged after treatment for pneumonia, cerebrovascular disease, or congestive heart failure with a length of stay > or = five days. During a nine-month period, the hospitals conducted four plan-do-study-act improvement cycles and shared their results in conference calls and group meetings. RESULTS: Statistically significant increases were noted from baseline (1/1/96-12/31/96) to follow-up (10/1/97-3/31/98) in identification of high-risk patients, repositioning of bed-bound or chair-bound patients, nutritional consults in malnourished patients, and staging of acquired Stage II pressure ulcers. Daily skin assessments occurred at a high rate in both periods. There were no statistically significant changes in other processes of care, pressure ulcer incidence, or mortality. DISCUSSION: Performance of four pressure ulcer prevention processes of care increased concurrently with a multifaceted improvement intervention.

Aged↗

PubMed1993

Geographic variation in the treatment of prostate cancer in Connecticut.

In Connecticut there was considerable variation by town of residence in the proportions of patients diagnosed in 1985-1988 receiving transurethral resection only, prostatectomy, and irradiation (without surgery) for local-stage prostate cancer and receiving endocrine surgery for late-stage prostate cancer. Age and socioeconomic variables were examined as predictors of this variation.

Age Factors↗

PubMed1991

Technology assessment in the Connecticut Tumor Registry.

A search of literature using the Connecticut Tumor Registry (CTR) for technology assessment produced eight articles. These articles represent a small but apparently increasing percentage (2%) of total CTR publications. By keeping pace with the development and dissemination of medical technologies, the population-based CTR has been useful for assessing them, especially their adverse effects.

Connecticut↗

PubMed2003

Alcohol use and risk of non-Hodgkin's lymphoma among Connecticut women (United States).

OBJECTIVE: Incidence rates of non-Hodgkin's lymphoma (NHL) have risen dramatically over the past several decades; however, the etiology of NHL remains largely unknown. Previous studies of the relationship between alcohol consumption and NHL have yielded conflicting results. Data from a population-based case-control study among women in Connecticut were analyzed to determine the potential impact of alcohol consumption on risk of NHL. METHODS: The study included 601 histologically confirmed, incident cases of NHL and 718 population-based controls. In-person interviews were administered using standardized, structured questionnaires to collect data on history of consumption for beer, wine, and liquor. RESULTS: When compared to non-drinkers, women who reported consumption of at least 12 drinks per year of any type of alcohol experienced slightly reduced risk of NHL (OR: 0.82; 95% CI: 0.65-1.04). Further stratification by alcohol type revealed that the inverse association was mainly limited to wine consumption (OR: 0.75; 95% CI: 0.59-0.96), with no clear association for beer or liquor consumption. Risk of NHL was further reduced with increasing duration of wine consumption (p for linear trend = 0.02). Consumption of wine for greater than 40 years was associated with approximately 40% reduction in risk (OR: 0.63; 95% CI: 0.44-0.91). CONCLUSION: Our results are consistent with several recent epidemiologic studies that have also suggested an inverse association between wine consumption and risk of NHL. The reduction in risk of NHL associated with increased duration of wine consumption warrants further investigation in other populations.

Adult↗

PubMed2004

Chemotherapy of nonelderly breast cancer patients by poverty-rate of area of residence in Connecticut.

For 684 nonelderly Connecticut women diagnosed in 1999 with early-stage breast cancer, routinely reported information on chemotherapy in a population-based cancer registry was supplemented by questionnaires to their physicians. Receipt of or recommendation for chemotherapy was associated with younger age, larger tumor size and positive lymph-node status, but not with higher poverty-rate (upper quintile) of census tract of residence at diagnosis. Similar studies are needed in other geographical areas that differ in socioeconomic indicators.

Adult↗