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PubMed1996

Community integration of former state hospital patients: outcomes of a policy shift in Vermont.

OBJECTIVE: The study examined the level of community integration achieved by patients discharged from the state hospital into the community in compliance with a regionalization policy in Vermont that sought to reduce the need for central hospitalization through expansion of community capacity. METHODS: The population in residence at the state hospital on August 30, 1989, was tracked longitudinally as patients were discharged into one of Vermont's ten catchment areas. Structured interviews about the current status of the discharged individuals were conducted four years later with case managers, nursing home personnel, and community care home operators. Service utilization and hospitalization data were obtained from the Vermont Department of Mental Health database. RESULTS: Of 122 patients in residence at the state hospital on the given date, 58 were discharged into the community, of whom 46 consented to participate in the study. At follow-up, about half lived in structured residential settings. Of the 46 followed, 87 percent were rehospitalized during the study period for periods ranging from three months to one year. Although participants had adequate levels of support both from within and outside the mental health system, their integration into the community was low in terms of their use of community resources, stigma-related problems, and difficulties gaining access to services. CONCLUSIONS: The regionalization policy accomplished some of its goals, especially those related to downsizing the state hospital, placing clients in community residential settings, and enhancing the range of community services. The more pervasive and insidious problems of community integration faced by consumers were not effectively mitigated by the policy.

Adult↗
PubMed1999

Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Network experience.

OBJECTIVE: The limited literature available to date suggests that the use of delivery room cardiopulmonary resuscitation (DR-CPR) is associated with very poor outcomes, especially for extremely low birth weight infants. We reviewed the cumulative experience of the Vermont Oxford Network to determine the actual utilization of DR-CPR and the neonatal outcomes of such infants. METHODS: A retrospective review of information available in the Vermont Oxford Network Database for the years 1994 to 1996. The data set was collected from 196 neonatal units who participate in the Network (data for infants 401 to 500 g were from 1996 only). Infants were eligible for study if they received DR-CPR defined as the administration of chest compressions and/or epinephrine in the delivery room as noted on the Vermont Oxford Network Database record. RESULTS: Information regarding survival was available for 27 707 newborns with birth weights from 501 to 1500 g, and 497 infants with birth weights from 401 to 500 g. There were 24 001 (86.6%) survivors. Overall DR-CPR was given to 9.3% of infants from 401 to 500 g and 6% of infants from 501 to 1500 g, 82.1% receiving chest compressions, and 66.7% receiving epinephrine. Survival of infants receiving DR-CPR was 23. 9% for infants of 401 to 500 g, and 63.3% for infants of 501 to 1500 g, compared with 16.7% and 87.9% for infants in these weight groups not receiving DR-CPR. Survival was greater for infants of 501 g or greater without DR-CPR compared with those who received this intervention within each 250-g birth weight subgroup. For infants of <1000 g, survival was 53.8% with DR-CPR compared with 74.9% without. Head ultrasounds were available for 95.5% of all surviving infants and 96.7% of infants who received DR-CPR. Overall, any grade of intraventricular hemorrhage (IVH) occurred more frequently in infants who received DR-CPR (38%) than in those who did not (21%). Grade 3 or 4 (severe) IVH was seen in 15.3% of infants who received DR-CPR compared with 4.9% of the infants who did not. Overall, survival without severe IVH occurred in 52.2% of DR-CPR infants compared with 81.3% of infants who did not require this intervention. CONCLUSION: The majority of very low birth weight and extremely low birth weight infants who receive DR-CPR survive, and at least half of such infants who survive do not have evidence of severe IVH. Further follow-up studies are required to determine the long-term neurodevelopmental outcome of such infants. The current study does not support the previously noted poor outcome in extremely low birth weight infants who receive DR-CPR.

Apgar Score↗
PubMed2001

Moving toward community-based care. Vermont's 10-year odyssey.

In Vermont, too much was spent on institutional care and not enough on home and community-based services. One study, written for Vermont's General Assembly, suggested that Vermont should work toward a gradual shift in spending with more spent on home care services and less on nursing home care.

Community Health Services↗
PubMedDate not supplied

Establishment of an exposure level to tetrachloroethylene in ambient air in Vermont.

Where environmental contaminants pose potential health hazards, health departments are involved in complex and often controversial situations. Often the rapid formation of a threshold exposure level is required to protect public health. A decision making process was implemented in Vermont when it became necessary to have an interim ambient air exposure level to test for tetrachloroethylene contamination in the water, air, and soil of a community. Contamination of public and private drinking water and ambient air in schools and homes was discovered as a result of uncontrolled waste disposal from an industrial uniform laundry and drycleaning plant. A telephone survey was conducted to determine action taken by the other 49 States regarding emission standards for tetrachloroethylene into ambient air. There were no guidelines in 25 States, and there were guidelines in the remaining 25. Vermont's Commissioner of Health convened a multidisciplinary group of public health professionals to review various approaches to the establishment of an ambient air standard. A decision making action using modified Delphi and nominal group consensus methods set the interim standard at 67 micrograms per cubic meter in ambient air. The drycleaning plant had been closed voluntarily before the standard was established, and the interim standard was used to prevent reopening of the plant through a health order issued by the Vermont Health Department. The standard was also useful for guidance during environmental remediation.

Air Pollutants↗
PubMedDate not supplied

Ophthalmia neonatorum prophylaxis in Vermont.

Vermont birth certificates and hospital medical charts for 1979 were reviewed to determine whether infants born at home or in hospitals had documentation of prophylaxis against gonococcal ophthalmia neonatorum. Of the 139 home births recorded in 1979, 78 infants (54.0 percent) received no prophylaxis, compared with 97 (1.4 percent) of 7,156 infants born in hospitals (P less than 0.0001). Ophthalmic medications that have not been recommended for use for neonatal prophylaxis were being used in two hospitals in the State. A followup review of 7,668 Vermont birth certificates for 1980 indicated that hospital practices improved in that year, after the hospitals received a reminder on proper prophylactic procedures from the Vermont Department of Health.

Birth Certificates↗
PubMed1997

Perceptions of child sexual abuse as a public health problem--Vermont, September 1995.

CDC and the World Health Organization have declared violence prevention a public health priority. One particular form of violent victimization, child sexual abuse, is a risk factor for suicide attempts, depression, sexually transmitted diseases, and subsequent sexual assault. The public health approaches to child sexual abuse are intervention (e.g., treatment) and prevention. To assist in developing public health measures for preventing child sexual abuse in Vermont, in September 1995, STOP IT NOW! and Market Street Research, Inc., surveyed a representative sample of households in Vermont to assess knowledge and attitudes about child sexual abuse as a public health problem. This report summarizes the survey findings, which indicate that levels of awareness of child sexual abuse are high among Vermont residents.

Awareness↗
PubMed2000

The association of increased weight, body mass index, and tissue density with the risk of breast carcinoma in Vermont.

BACKGROUND: Etiologic studies of breast carcinoma have indicated that weight, body mass index (BMI), and breast tissue density are important determinants of a woman's risk for the disease. This study looked at the independent effects of these risk factors. METHODS: Data from the Vermont Breast Cancer Surveillance System (VBCSS), collected between May 1996 and November 1997, were used to identify 529 breast carcinoma cases with no prior history of the disease. Each case was matched to four randomly chosen women of the same age who had mammograms during the same time period and had no biopsy-confirmed breast carcinoma. Logistic regression was used to assess the effects of weight, BMI, and breast tissue density on breast carcinoma risk for pre- and postmenopausal women. RESULTS: Weight and BMI were found to be significantly associated with postmenopausal breast carcinoma after adjustment for breast density, and vice versa. The density-adjusted odds ratio for women weighing over 81 kg, relative to women weighing under 63 kg, was 2.1, with a 95% confidence interval (CI) of 1.3-3.2. Relative to women with breasts consisting entirely of fat, the weight-adjusted odds ratios for women with heterogeneously dense and extremely dense breasts were 2.3 (CI: 1.3-4.3) and 4.5 (CI: 1.9-10.6), respectively. CONCLUSIONS: Among postmenopausal Vermont women, weight, BMI, and breast density were independently associated with breast carcinoma risk. Because breast density and weight or BMI are inversely related, estimates of their independent effects should be used when evaluating a woman's risk for breast carcinoma.

Adult↗
PubMed2005

Long-term atmospheric mercury wet deposition at Underhill, Vermont.

Section 112(m) of the 1990 Clean Air Act Amendments, referred to as the Great Waters Program, mandated an assessment of atmospheric deposition of hazardous air pollutants (HAPs) to Lake Champlain. Mercury (Hg) was listed as a priority HAP and has continued to be a high priority for a number of national and international programs. An assessment of the magnitude and seasonal variation of atmospheric Hg levels and deposition in the Lake Champlain basin was initiated in December 1992 which included event precipitation collection, as well as collection of vapor and particle phase Hg in ambient air. Sampling was performed at the Proctor Maple Research Center in Underhill Center, VT. The range in the annual volume-weighted mean concentration for Hg in precipitation was 7.8-10.5 ng/l for the 11-year sampling period and the average amount of Hg deposited with each precipitation event was 0.10 microg/m2. The average amount of Hg deposited through precipitation each year from 1993 to 2003 was 9.7 microg/m2/yr. A seasonal pattern for Hg in precipitation is clearly evident, with increased Hg concentrations and deposition observed during spring and summer months. While a clear trend in the 11-year event deposition record at Underhill was not observed, a significant decrease in the event max-to-monthly ratio was observed suggesting that a major source influence was controlled over time. Discrete precipitation events were responsible for significant fractions of the monthly and annual loading of Hg to the forested ecosystem in Vermont. Monthly-averaged temperatures were found to be moderately correlated with monthly volume-weighted mean Hg concentrations (r2 = 0.61) and Hg deposition (r2 = 0.67) recorded at the Vermont site. Meteorological analysis indicated the highest levels of Hg in precipitation were associated with regional transport from the west, southwest, and south during the warmer months.

Air Pollutants↗
PubMed1995

Treated injuries in northern Vermont.

OBJECTIVES: To study characteristics of injury events and injuries requiring treatment in a Vermont population. METHOD: A one year 30% prospective sample was studied of persons from 22 communities who received first physician care for injury at the Medical Center Hospital of Vermont. RESULTS: Modal injuries were-superficial involving skin only among children below age 10, overexertion injuries among 10-59 year olds, and fractures among older persons. Among interviewed males ages 20-59, 31% of injuries were work related. Among females 26% were work related. Examining hospitalized cases only would have overemphasized falls, chemical injuries, leg fractures, transportation and nursing home injuries, and undercounted overexertion injuries, especially to the back, arm fractures, and injuries during recreation, work and home activities. Most common products/materials in use when injured were recreational equipment (24%) and motor vehicles (9%). Those most often causing injury were ground (20%) and home structures/construction materials (17%). No product was involved in 39% of injury event initiation and 15% of injury causation. CONCLUSION: In order to adequately reflect the distribution of treated injuries in the community by anatomical area, age, and event type studies must examine both emergency department and hospitalized cases and use a data collection system capable of recording several parameters to describe injury events and products/materials involved.

Accident Prevention↗
PubMed1995

An assessment of data quality in the Vermont-Oxford Trials Network database.

The Vermont-Oxford Trials Network is a voluntary collaborative research group of neonatologists that maintains a database for very low birthweight infants (501-1500 g). The database (1) provides core data for randomized trials, (2) serves as a resource for outcomes research in neonatology, and (3) generates quality management reports for participating sites. To assess the reliability of this database and to determine the sources of error, we reviewed 635 medical records chosen at random from among the 4341 eligible infants born at 40 participating data generating sites during an 18-month period beginning January 1, 1990. The estimated frequencies of disagreement between the medical record and database for each of the 10 data items studied and the standard errors of the estimates (in parentheses) were: date of birth 1.3% (0.4), date of admission 2.5% (0.6), date of discharge 8.8% (1.0), birthweight (difference > 50 g) 2.9% (0.6), location of birth (inborn or outborn) 2.1% (0.5), multiple birth 2.2% (0.5), cesarean section 2.5% (0.6), gender 2.1% (0.5), status 28 days after birth 3.4% (0.6), final status 2.9% (0.6). The overall proportions and mean values for items in the database were close to the estimated values based on the random sample of records. There were a total of 247 disagreements between the database and the medical records in the sample. Twenty-three were due to data keying errors. Two hundred twenty-four were due to errors in transcription or interpretation. The rate of data keying errors decreased from over 50 errors per 10,000 fields to less than 15 errors per 10,000 fields when specific quality control procedures, including visual inspection, were instituted. Data keying errors accounted for 13.7% of all disagreements between the database and medical record before improved data entry methods were introduced, and only 3.7% of all errors after they were introduced. We concluded that the Vermont-Oxford Trials Network Database is reliable. Data keying errors have been reduced by the introduction of additional quality control measures. Further reductions in database errors will require measures aimed at minimizing transcription or interpretation errors by individuals completing the data forms.

Computer Communication Networks↗
PubMed2005

The pathology student fellowship program at the University of Vermont: 1956-2005.

Student fellowship programs in pathology offer a unique educational experience for selected medical students. In this report, the specialty preferences of former student fellows graduating from the University of Vermont were analyzed. Since 1956, 110 students have participated in this program, of whom 33 chose pathology as a career. These individuals represented 32.6% of all Vermont graduates who entered pathology between 1958 and 2005. In addition, former student fellows were more likely to become academic pathologists and to obtain subspecialty certification. Furthermore, based on comments received from former student fellows, the program had a positive impact on the medical education and career of pathologists and nonpathologists alike. It is concluded that student fellowship programs represent a powerful recruitment tool for pathology generally and for academic pathology in particular. The development of a database to track these programs and their graduates is essential to fully assess the educational impact of pathology student fellowship programs nationally.

Education, Medical, Graduate↗
PubMed2001

Atmospheric aerosol over Vermont: chemical composition and sources.

Aerosol chemical composition data for PM2.5 samples collected during the period from 1988 to 1995 at Underhill, VT, were analyzed. Sulfur and black carbon mass concentrations ranged from 0.01 to 6.5 microg m(-3) and from 0.05 to 2.2 microg m(-3), respectively, while the total fine aerosol mass concentration ranged from 0.2 to 51.1 microg m(-3). Seasonal variations with maxima during the summer and minima in winter/spring were observed for sulfur and the fine mass concentrations. No annual pattern was observed for black carbon. Seasonal variations for most of the other anthropogenic species had maxima in winter and spring and minima in the summer. A factor analysis method, positive matrix factorization (PMF), utilizing error estimates of the data to provide optimum data point scaling was used to obtain information about possible sources of the aerosol. An 11-factor solution was obtained. The six sources representing wood burning, coal and oil combustion, coal combustion emissions plus photochemical sulfate production, metal production plus municipal waste incineration, and emissions from motor vehicles were identified. Emissions from smelting of nonferrous metal ores, arsenic smelting, and soil particles and particles with high concentrations of Na were also identified by PMF. Potential source contribution function (PSCF) analysis combines the aerosol data with the air parcel backward trajectories. PSCF was applied to identify possible source areas and pathways that give rise to the observed high particulate mass concentrations from these 11 sources. The CAPITA Monte Carlo trajectory model was used to obtain 10 sets of 5-day air parcel back trajectories arriving every 2 h for the 7-yr period from 1988 to 1995. The PSCF plot for the black carbon factor shows high probabilities in the area surrounding the sampling site, indicating a strong local influence from residential wood combustion in northern New England and southwestern Quebec. Similar large potential source areas in the midwestern United States were identified for the two coal combustion factors. The midwestern United States was also identified as the source region for the Zn-Pb factor. The oil combustion factor was associated with the east coast of the United States. The results for the Pb-Mn factor suggests high probability over the nearby Montreal urban area and the areas in the midwestern United States. The windblown dust emissions from the areas to the north are significant contributors for the soil factor. Canadian Ni smelters are the main sources for the As factor, although there is some contribution from coal-fired power plants to the south and west of Underhill, VT. It is concluded that the combination of the two receptor modeling methods, PMF and PSCF, provides an effective way in identifying atmospheric aerosol sources and their likely locations. Emissions from different anthropogenic activities as well as secondary aerosol production are the main sources of aerosol measured in Vermont. Fuel combustion, local wood smoke, municipal waste incineration, and the secondary sulfate production collectively accounted for about 87% of the fine mass concentrations measured in Vermont.

Aerosols↗
PubMed1975

Undiagnosed bacterial meningitis in Vermont children.

Community-acquired bacterial meningitis in Vermont children under 5 years of age was recognized less frequently in 1967-1970 in those towns with low total hospitalization rates than in towns with hospitalization rates above 15 admissions per 100 population. Using the towns with high hospitalization rates as a norm, it was found that towns with fewer recognized meningitis cases than expected had significantly greater rates of death from obscure causes in children 1-59 months of age in 1967-1970. It is suggested that about 17 deaths in 1967-1970 in Vermont children 1-59 months of age were associated with the failure to recognize bacterial meningitis in children from towns with low rates of medical care utilization.

Bacterial Infections↗
PubMed1989

Epidemiologic surveillance for endemic Giardia lamblia infection in Vermont. The roles of waterborne and person-to-person transmission.

The authors studied 1,211 laboratory-confirmed, non-outbreak-related cases of giardiasis in Vermont residents reported through Vermont's laboratory-based active surveillance system between 1983 and 1986. Giardiasis was the most common reportable disease in the state, with an average annual incidence rate of 45.9 cases per 100,000 population per year. This rate is higher than that in other states reporting giardiasis incidence. Morbidity from giardiasis was also significant in that 30% of cases reported symptoms lasting four or more weeks. Waterborne transmission was suggested to be an important cause of non-outbreak-related cases because rates of infection were highest in persons receiving nonfiltered municipal or nonmunicipal residential drinking water. Rates were also higher at higher elevations, where water supplies may be difficult to protect from contamination. In addition, the pattern of age-specific incidence rates and the high estimated incidence of infection in children attending day care suggested that person-to-person transmission also played a role in causing non-outbreak-related cases. Routine surveillance data can serve to indicate likely important routes of transmission of giardiasis in the community.

Adolescent↗
PubMedDate not supplied

Enhancing nuclear emergency preparedness: Vermont's distribution program for potassium iodide.

On January 31, 2002, Vermont's health commissioner requested potassium iodide (KI) for individuals in the 10-mile Emergency Planning Zone of the nuclear power facility. Vermont's KI distribution program emphasized public information about the role, risks, and benefits of KI. Predistribution ensured that individuals could receive KI in a 0- to 4-hour time period, to provide maximum protection. Five months after the program began, more than 1,000 individuals had received KI, and 3,000-4,000 KI doses have been distributed in schools. Efforts are ongoing to identify barriers to participation, provide public education, and evaluate KI distribution efforts.

Community Participation↗
PubMed2003

Human papillomavirus (HPV) education in middle and high schools of Vermont.

Human papillomavirus (HPV), the most prevalent sexually transmitted disease (STD), continues to pose a significant public health problem especially among the adolescent population. Most precancerous and cancerous cervical changes are associated with HPV, with adolescent women being biologically at highest risk for acquiring HPV. This survey examined the type of information taught to adolescents about HPV, and specific needs for effective HPV education in middle and high schools in Vermont. The survey addressed knowledge level, behavior, attitudes, enabling factors, motivators, and barriers. Data were analyzed by descriptive statistics and supplemented with contingency table analyses. Replies (n = 108) were received from 79 schools, with 60% of responses from nurses and 40% from teachers. In five of eight questions addressing basic knowledge of HPV, less than 60% of respondents gave the correct answer. Most (73%) felt it was important to teach about HPV relative to HIV/AIDS, but spent less classroom time teaching it. Main motivations for teaching about HPV were its importance, and a desire to increase student knowledge and prevention skills. Main barriers perceived were lack of time and materials and curricula, and need for more knowledge about HPV. The most prominent needs indicated included brochures for students, an increase in the educators' knowledge base, and a high school curriculum. Health educators in Vermont schools recognize the importance of teaching adolescents about HPV, but they lack basic knowledge and resources for teaching about HPV.

Adolescent↗
PubMed2004

Attitudes, perceived norms, and intentions: a needs assessment study of the influenza immunization intentions of elderly citizens in Vermont.

CONTEXT: Influenza and pneumonia rank among the 5 leading causes of death among persons aged 65 and over. Although immunization has been demonstrated to prevent influenza or reduce its incidence and associated complications among the elderly, it has been largely underutilized. PURPOSE: This study examined the association of attitudes, perceived norms, and intention to obtain influenza immunization among community-dwelling rural elderly. The goal was to design an effective intervention program to increase the rate of flu immunization among the rural elderly. METHODS: In spring 2000, random-digit dialing selected 1,239 households in 2 rural Vermont counties. Telephone interviews were conducted with 799 persons aged 60 or older, resulting in a response rate of 65%. FINDINGS: Factor analyses revealed 2 dimensions underlying attitudes and perceived norms. Subsequent regression analyses confirmed that 1 attitude construct--perceived benefits--and both normative indices were significant predictors of immunization intention, explaining 45% of its variation. CONCLUSIONS: An intervention program targeting rural elderly should emphasize the benefits and perceived side effects of immunization. The program should publicize that most elderly believe that the advantages of influenza immunization outweigh the disadvantages. These findings will inform an intervention program designed to increase immunization coverage among rural seniors in Vermont.

Aged↗
PubMed1979

Farmer's lung disease in Vermont.

Several Vermont population groups were surveyed for the occurrence of antibodies to thermophilic actinomycetes. Antibodies to M. faeni and T. vulgaris were measured by the precipitin method in all subjects and, in 124 subjects, M. faeni antibodies were also measured by the indirect fluorescent antibody (IFA) technique. There was relatively good correlation between the two techniques (r 0.48, p less than 0.01). Hospital employees, blood donors and patients with chronic bronchitis were generally negative for precipitins to thermophilic actinomycetes. Of the 258 Vermont dairy farmers surveyed, 14 (5.4%) had precipitins to M. faeni, 3 (1.2%) had precipitins to T. vulgaris but only 1 farmer with antibodies to M. faeni had symptoms of possible farmer's lung disease (FLD). On the other hand, 10 (4.1%) precipitin-negative farmers had symptoms possibly consistent with FLD. The IFA test did not correlate any better with symptoms. 7 (5.6%) patients with pulmonary fibrosis had precipitins to M. faeni 5 of these were diagnosed as having FLD. 18 (14.4%) had precipitins to T. vulgaris and only 3 of these patients were felt to have hypersensitivity pneumonitis. Patients with pulmonary fibrosis and FLD hat IFA titers of greater than or equal to 1/128, but so did asymptomatic farmers.

Adolescent↗