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PubMed2001

The epidemiology of work and work-related disease in Rhode Island, 1876-2001.

Most Rhode Island workers now work in service industries, though many workers continue to be exposed to the risks of goods production in the workplace. Most reported occupational death is related to transportation and homicide, although in Rhode Island in 1999, exposure to harmful substances or environments was a significant cause of Rhode Island's few occupationally related deaths. How much occupational and environmental exposure contributes to Rhode Island's heart disease and cancer mortality rates in unknown. Musculoskeletal injuries are the predominant form of reported non-fatal occupational injuries, but there are questions about the completeness and accuracy of data on occupational injury and death.

History, 19th Century↗
PubMed1990

Mammography referral patterns among Rhode Island physicians.

In 1987, the Rhode Island Department of Health conducted a survey of Rhode Island primary care physicians to determine their attitudes and practices regarding breast cancer screening, particularly their use of clinical breast exam (CBE) and referral for screening mammography, and compared the data with information obtained from primary care physicians in the US in 1984 and 1989. The survey showed that the same percentage of Rhode Island physicians (71%) and physicians nationally (72%) agree with American Cancer Society (ACS) guidelines for breast cancer screening, but Rhode Island physicians refer for mammography (43 vs 37%) and perform CBE (97 vs 80%) according to ACS guidelines more frequently. Cost, reliability and availability were of greater concern to physicians nationally than in Rhode Island. Despite better use of breast cancer screening by Rhode Island physicians, only 43% reported referring for mammography according to guidelines. Since studies indicate that the recommendation of her physician is a key determinant of a woman's decision to have a screening mammogram, physician referral needs to increase in order to meet the Year 2000 Objectives of 80% for screening mammography for women 40 and older.

Adult↗
PubMed1990

Cancer control in Rhode Island: blueprint for the 1990s.

Rhode Island has one of the highest cancer mortality rates in the nation. In an average year, about 5000 new cancers are reported to the Rhode Island Cancer Registry, and more than 2300 Rhode Islanders succumb to the disease. In response to this problem the Rhode Island Department of Health assembled cancer experts from around the state to plan priority cancer control activities for the 1990s. Their plan for 1990-1992 is the subject of this report. Five cancers were selected as the foci of cancer control activities: cancers of the lung, colon-rectum, breast, cervix, and oral cavity. The plan proposes prevention, screening, and treatment interventions to reduce morbidity and mortality from these diseases. Rhode Islanders will have to work together to achieve the 33% reduction in cancer mortality proposed as a goal for the year 2000. Surveillance suggests progress on some fronts, but marching in place on others.

Adolescent↗
PubMed1990

Salt marsh mosquito control in Portsmouth, Rhode Island.

The Portsmouth, Rhode Island Mosquito Control Program used granular Bacillus thuringiensis var. israelensis to successfully control salt marsh mosquitoes in a 9 acre salt marsh while monitoring for, planning and implementing small scale open marsh water management in the marsh. Single season larviciding costs were roughly 4% that of contracted open marsh water management in this marsh.

Aedes↗
PubMed1991

Childhood lead poisoning: a Rhode Island perspective.

The Rhode Island Department of Health recognizes lead exposure as the State's most important environmental health problem. Historically, the program has relied on secondary prevention strategies consisting primarily of screening, case-finding, limited environmental intervention and medical management. While secondary prevention of lead toxicity identifies existing cases in a preclinical stage, it does not prevent exposure to lead hazards. The sources of lead exposure need to be appropriately identified and abated if exposures and re-exposures are to be prevented. Because of the ubiquity of lead and practical limitations of available resources, a large number of children with elevated blood lead levels will continue to go unscreened and undetected unless more effective screening strategies are implemented. Present reliance on the free erythrocyte protoporphyrin (FEP) test as a primary screening tool is recognized as an insensitive way to identify children with blood lead levels below 40 micrograms %. With growing evidence of toxicity and long term health effects associated with blood lead levels in the range between 10 and 40 micrograms %, blood lead analysis will need to become part of the routine method of screening.

Child↗
PubMed1994

Epidemiologic investigation of nonmelanoma skin cancer mortality: the Rhode Island Follow-Back Study.

The Rhode Island Follow-Back Study was initiated to elucidate the magnitude and characteristics of nonmelanoma skin cancer mortality. All deaths reported among Rhode Island residents during 1979 through 1987 and attributed to nonmelanoma skin cancer were investigated and medical records sought. Most were misclassified, primarily due to squamous cell carcinoma of mucosal surfaces in the head and neck. In Rhode Island and nationally, this source of misclassification is increasingly frequent. Appropriate adjustment of national statistics for misclassification reveals a consistent decline in nonmelanoma skin cancer mortality rates from 1969 through 1988, although the actual numbers of deaths are increasing due to growth and aging of the population. Examination of the records of those Rhode Island residents who did die from nonmelanoma skin cancer demonstrated that most had squamous cell carcinoma, and many of those arose from the ear. These analyses suggest that particular emphasis should be placed on the ear in public health campaigns geared toward the prevention and early detection of nonmelanoma skin cancer.

Carcinoma, Squamous Cell↗
PubMed1976

22. Some successes and failures with long-term care data systems: the Rhode Island experience.

A project by Rhode Island Health Services Research (SEARCH) to develop, adapt, and improve data systems in several Rhode Island long-term care settings includes skilled nursing and intermediate care facilities, two chronic care hospitals, mental health institutions, and home health agencies. A successful medical review system was developed for Medicaid nursing home patients which is now a program funded by the state, as well as a good abstracting system for the two chronic hospitals. Also, steps were taken to correct omissions and inaccuracies found in mental health data used in the Multi-State Information System (MSIS), and to modify a limited management information system used by home health agencies. In retrospect, the project would have been better served had it attempted to be less comprehensive and instead focused its resources in areas of high visibility and unequivocal public concern. The approach would have given the state population-based information of much greater power than is currently available, despite the recognized successes of the project in the nursing home and chronic hospital areas.

Chronic Disease↗
PubMed1996

Setting limits through global budgeting: hospital cost containment in Rhode Island.

In 1974, hospitals in Rhode Island have participated in annual negotiations with state officials and representatives from Blue Cross to determine the allowed increase in statewide hospital costs (the "Maxicap") for the next fiscal year, based on projected increases in hospitals' revenues, changes in patient volume and operating expenses. Individual hospital budgets may be above or below the Maxicap as long as the total increase in hospital costs for all hospitals in the state does not exceed the negotiated amount. At a time when regulatory solutions are increasingly under fire, continued support for Rhode Island's approach to hospital cost containment from third party payers, providers and public officials stands in stark contrast to other states where rate setting was either dismantled or discredited as a cost control strategy. A negotiated global cap on hospital expenditures offers an alternative to formula-based state rate-setting methodologies which could be incorporated as part of an all-payer reimbursement methodology or as an incremental step towards more comprehensive reform.

Blue Cross Blue Shield Insurance Plans↗
PubMed1991

Program to increase the accessibility of screening mammography--Rhode Island, 1987-1988.

The Rhode Island Department of Health's (RIDH) Breast Cancer Screening Program (RIBCSP) was initiated in 1987; it includes a broad promotional effort targeting women and physicians, a strong quality-assurance program, reductions in the cost of the breast cancer screening examination, and a telephone appointment and tracking system for screening examinations and follow-up care. This report describes and summarizes an evaluation of the RIBCSP.

Adult↗
PubMed1991

Older Rhode Islanders: demography, health status and the implications for the practice of medicine.

There is a large and growing elderly population in Rhode Island and that population is getting older. Rhode Island's elders are maldistributed geographically and represent a larger proportion of the population than nationally. Most have significant chronic conditions and many have major limitations in functional abilities. Relatively few reside in long-term care facilities and generally, the community-dwelling population rates their health favorably. The elderly in Rhode Island make more physician visits than any other segment of the population and account for a disproportionate number of hospital and nursing home days. The number of primary care physicians practicing adult medicine in Rhode Island has diminished and if the trends of graduating medical students continue, further decreases are to be expected. The costs of health care for the elderly in Rhode Island have skyrocketed over the last 20 years, and are projected to continue to increase dramatically over the next 40-50 years in part as a result in the growth of the state's elderly population. These cost increases will be magnified if health care costs in general continue to outpace other segments of our economy. If Rhode Island is to adequately meet the health care needs of older Rhode Islanders over the next 40-50 years, major changes must occur. Initiatives to prevent or forestall the onset of chronic illnesses and resultant functional limitations are likely to improve the quality of life of older Rhode Islanders as well as positively influence the costs of health care for this segment of our state's population.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Epidemiology of tuberculosis in Rhode Island.

The increase in the reported cases of tuberculosis in Rhode Island from 1985 to 1991 has been striking. This rise has occurred at a faster rate than that for the United States overall. Although the HIV epidemic is largely to blame for the resurgence of tuberculosis nationwide, its impact on tuberculosis locally has been muted. The rise in reported cases in Rhode Island is attributable mainly to increased cases among minority groups, particularly Southeast Asians. Blacks and Hispanics are likewise at an increased risk for developing active disease. Especially alarming is the dramatic rise in the number of tuberculosis cases reported in children in Rhode Island, a reflection of active disease transmission in the community. The Rhode Island Tuberculosis Control Program, already functioning at full capacity, must find ways of curbing the growing tuberculosis problem.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Development of guidelines on nonoccupational HIV postexposure prophylaxis for the state of Rhode Island.

The Brown University AIDS Program and the Rhode Island Department of Health joined with health care practitioners, researchers, and representatives of community-based health, social service, and advocacy organizations to create comprehensive guidelines on nonoccupational HIV postexposure prophylaxis for the state of Rhode Island. These guidelines offer health care practitioners detailed advice on the evaluation and management of blood or body fluid exposures outside the health care setting, e.g., through sexual assault, consensual sex, injecting-drug use, or needlestick injuries. In these circumstances, HIV postexposure prophylaxis serves those for whom primary prevention measures have failed or were impractical or impossible. The guidelines represent the end product of coordination among private and public, academic and nonacademic, clinician and layperson groups committed to decreasing the incidence of HIV infections in the state of Rhode Island. The guidelines serve as both a resource for health care practitioners and a means of educating them on this method of HIV prevention.

Anti-HIV Agents↗