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PubMed1996

Factors influencing Cryptosporidium testing in Connecticut.

To describe patterns of testing for Cryptosporidium oocysts in stool samples, Connecticut laboratories were surveyed. Different detection methods were used. Most laboratories examined stools specifically for Cryptosporidium only on physician request. The rate of positive tests varted widely (0 to 28%). Higher rates of positivity were associated with the use of monoclonal antibody methods, the use of two or more staining procedures, and testing of stool specimens in addition to those requested by physicians.

Animals↗
PubMed1997

Survey of emm gene sequences and T-antigen types from systemic Streptococcus pyogenes infection isolates collected in San Francisco, California; Atlanta, Georgia; and Connecticut in 1994 and 1995.

The variable 5' emm (M-protein gene) sequences and T-antigen types were determined from 340 systemic group A streptococcal (GAS) isolates taken from hospitalized patients in San Francisco, Calif.; Atlanta, Ga.; and Connecticut in 1994 and 1995. Eighty percent of these isolates had emm sequences and T-antigen types in agreement with previously recorded M- and T-antigen associations. Most of the remaining strains either were T nontypeable (11%) or contained emm genes encoding M proteins for which T-antigen associations have not been made (6%). One newly encountered emm gene, designated ST2974, from each of 13 isolates had the T type 8/25/Imp19. Another new emm gene, ST2967, from 8 of 11 isolates was T nontypeable. Six other unique emm gene sequences from seven isolates were encountered. Sequencing of the variable region of the emm gene of GAS isolates (emm typing) is effective for surveying the sequence variability of the M virulence protein, and combined with T typing, emm typing is useful for monitoring GAS strain diversity.

Amino Acid Sequence↗
PubMed1998

Human exposure to a granulocytic Ehrlichia and other tick-borne agents in Connecticut.

Indirect fluorescent-antibody (IFA) staining methods with Ehrlichia equi (MRK or BDS strains) and Western blot analyses containing a human granulocytic ehrlichiosis (HGE) agent (NCH-1 strain) were used to confirm probable human cases of infection in Connecticut during 1995 and 1996. Also included were other tests for Ehrlichia chaffeensis, the agent of human monocytic ehrlichiosis (HME), Babesia microti, and Borrelia burgdorferi. Thirty-three (8.8%) of 375 patients who had fever accompanied by marked leukopenia or thrombocytopenia were serologically confirmed as having HGE. Western blot analyses of a subset of positive sera confirmed the results of the IFA staining methods for 15 (78.9%) of 19 seropositive specimens obtained from different persons. There was frequent detection of antibodies to a 44-kDa protein of the HGE agent. Serologic testing also revealed possible cases of Lyme borreliosis (n = 142), babesiosis (n = 41), and HME (n = 21). Forty-seven (26.1%) of 180 patients had antibodies to two or more tick-borne agents. Therefore, when one of these diseases is clinically suspected or diagnosed, clinicians should consider the possibility of other current or past tick-borne infections.

Animals↗
PubMed1999

Detection and reporting of organisms producing extended-spectrum beta-lactamases: survey of laboratories in Connecticut.

Extended-spectrum beta-lactamases (ESBLs) are enzymes produced in some gram-negative bacilli that mediate resistance to extended-spectrum cephalosporins and aztreonam. They are most common in Klebsiella spp. and Escherichia coli but are present in a variety of Enterobacteriaceae. Resistance mediated by these enzymes can be difficult to detect depending on the antimicrobial agents tested. AmpC beta-lactamases are related to the chromosomal enzymes of Enterobacter and Citrobacter spp. and also mediate resistance to extended-spectrum cephalosporins and aztreonam in addition to cephamycins, such as cefoxitin. Unlike ESBLs, however, AmpC beta-lactamases are not inhibited by clavulanic acid or other similar compounds. To assess the abilities of various antimicrobial susceptibility testing methods to detect ESBLs, we sent three ESBL-producing organisms, one AmpC-producing organism, and a control strain that was susceptible to extended-spectrum cephalosporins to 38 laboratories in Connecticut for testing. Eight (21.0%) of 38 labs failed to detect extended-spectrum cephalosporin or aztreonam resistance in any of the ESBL- or AmpC-producing isolates. Errors were encountered with both automated and disk diffusion methods. Conversely, seven (18.4%) labs categorized at least some of the four resistant isolates as potential ESBL producers and reported the results with the extended-spectrum cephalosporins and aztreonam as resistant as suggested by current National Committee for Clinical Laboratory Standards (NCCLS) guidelines. The percentage of laboratories that failed to detect resistance in the ESBL or AmpC isolates ranged from 23.7 to 31.6% depending on the type of enzyme present in the test organism. This survey suggests that many laboratories have difficulty detecting resistance in ESBL and AmpC-producing organisms and may be unaware of the NCCLS guidelines on modifying susceptibility testing reports for ESBL-producing strains.

Aztreonam↗
PubMed1998

Injury reporting in Connecticut newspapers.

OBJECTIVES: To describe how newspapers report injury events and how often they contain information about injury prevention measures. METHODS: A commercial service provided all newspaper clippings reporting unintentional injury events between July and September 1995 from 17 daily and 55 weekly newspapers published in Connecticut, USA. Each clipping was reviewed to determine the presence or absence of 35 content variables. RESULTS: There were 962 articles and excluding 35 editorials, 927 reported injury events and 17% pertained to persons under 21 years. Of the 60% that described motor vehicle collisions only 3% mentioned driver alcohol use, 9% seat belt use, and fewer than 1% airbag use. In the 17 motorcycle and 44 bicycle stories, 29% and 20% respectively, mentioned helmet use. In the 16 articles about house fires only 13% mentioned smoke detector use. There were no significant differences in injury reporting by circulation size. CONCLUSIONS: Newspapers are an important source of public information but are woefully deficient in providing information on injury prevention.

Accident Prevention↗
PubMed1984

Antibodies to Rickettsia rickettsii in Peromyscus leucopus from a focus of Rocky Mountain spotted fever in Connecticut.

During 1980-1982, white-footed mice (Peromyscus leucopus) were captured in Newtown, Connecticut, an area where Rickettsia rickettsii, the etiologic agent of Rocky Mountain spotted fever, is thought to be enzootic. An indirect microimmunofluorescence test identified specific antibodies to this organism in 16 of 237 (7%) sera: titration end points for 14 samples were relatively high (1:128-1:2048). Antibodies were detected in mice during 1980 and 1981 with monthly prevalences varying from 8 to 22%. These results suggest that P. leucopus may be involved in the ecology of R. rickettsii and that these rodents can be included along with other mammals to monitor spotted fever rickettsial infections in nature.

Animals↗
PubMed1985

Spotted fever group rickettsiae in immature and adult ticks (Acari: Ixodidae) from a focus of Rocky Mountain spotted fever in Connecticut.

Immature and adult ixodid ticks were collected during 1983 and 1984 in Newtown, Connecticut, an area endemic for Rocky Mountain spotted fever (RMSF), to determine prevalence of infection by spotted fever group (SFG) rickettsiae. Direct fluorescent-antibody (FA) staining revealed SFG organisms in 6 (1.8%) of 332 Dermacentor variabilis larvae, 5 (7.8%) of 64 D. variabilis nymphs, and in 2 (40%) of 5 Ixodes cookei nymphs removed from small- and medium-sized mammals. Hemolymph tests detected rickettsia-like organisms in 15 (8.8%) of 170 D. variabilis adults; 8 specimens retested by direct FA were negative. In contrast, hemocytes from 5 (8.6%) of 58 Ixodes texanus females contained organisms that stained positively in both hemolymph and direct FA tests. An indirect microimmunofluorescence test identified specific antibodies to Rickettsia rickettsii, the etiologic agent of RMSF, in serum samples from a chipmunk, raccoons, and white-footed mice. Results indicate that immature or adult ticks of at least three species may be involved in the maintenance and transmission of SFG rickettsiae at Newtown.

Animals↗
PubMed2006

Risk of multiple myeloma following medication use and medical conditions: a case-control study in Connecticut women.

BACKGROUND: Certain commonly used drugs and medical conditions characterized by chronic immune dysfunction and/or antigen stimulation have been suggested to affect important pathways in multiple myeloma tumor cell growth and survival. We conducted a population-based case-control study to investigate the role of medical history in the etiology of multiple myeloma among Connecticut women. METHODS: A total of 179 incident multiple myeloma cases (21-84 years, diagnosed 1996-2002) and 691 population-based controls was included in this study. Information on medical conditions, medications, and medical radiation was obtained by in-person interviews. We calculated odds ratios (OR) as measures of relative risks using logistic regression models. RESULTS: A reduced multiple myeloma risk was found among women who had used antilipid statin therapy [OR, 0.4; 95% confidence interval (95% CI), 0.2-0.8] or estrogen replacement therapy (OR, 0.6; 95% CI, 0.4-0.99) or who had a medical history of allergy (OR, 0.4; 95% CI, 0.3-0.7), scarlet fever (OR, 0.5; 95% CI, 0.2-0.9), or bursitis (OR, 0.4; 95% CI, 0.2-0.7). An increased risk of multiple myeloma was found among women who used prednisone (OR, 5.1; 95% CI, 1.8-14.4), insulin (OR, 3.1; 95% CI, 1.1-9.0), or gout medication (OR, 6.7; 95% CI, 1.2-38.0). CONCLUSIONS: If our results are confirmed, mechanistic studies examining how prior use of insulin, prednisone, and, perhaps, gout medication might promote increased occurrence of multiple myeloma and how antilipid statins, estrogen replacement therapy, and certain medical conditions might protect against multiple myeloma may provide insights to the as yet unknown etiology of multiple myeloma.

Adult↗
PubMed2003

Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid managed care.

OBJECTIVES: The authors sought to determine the prevalence, patterns, and demographic correlates of multiple psychotropic pharmacotherapy in a statewide sample of low-income children and adolescents in community-based clinical care. METHODS: The Medicaid managed care database of the Connecticut Department of Social Services was the source of linked encounter and pharmacy information for the one-year period ending June 30, 1999. Period prevalence was calculated for children and adolescents ranging in age from newborn through 18 years who had any psychotropic drug prescription claims during the study period. For each participant, multiple psychotropic pharmacotherapy was defined as having claims for prescriptions for medications in two or more different psychotropic drug classes during a seven-day period. Age, gender, race, and state custody status were examined across groups, and multiple psychotropic pharmacotherapy patterns were identified. RESULTS: Of the 196,505 youths in Medicaid managed care, 9,447 received at least one psychotropic medication, yielding a period prevalence of 4.8 percent. Among youths who received psychotropics, 13.6 percent had received multiple psychotropic pharmacotherapy. Multivariate logistic regression revealed that participants who received psychotropics, alone or in combination, were significantly more likely to be in state custody, male, and older than other participants and less likely to be African American or Hispanic. Stimulants, antidepressants, and mood stabilizers were the most commonly dispensed agents. The most common drug class combinations were an antidepressant plus an antipsychotic, a stimulant plus an antidepressant, and a stimulant plus an alpha(2) agonist. CONCLUSIONS: Our findings revealed sociodemographic differences in psychopharmacological care among young Medicaid managed care enrollees and the common occurrence of multiple psychotropic pharmacotherapy.

Adolescent↗
PubMed1978

Competency evaluations in Connecticut.

New procedures for conducting competency evaluations were adopted in Connecticut in 1975 as a result of a change in the state law. The accused person is now evaluated in the setting in which he finds himself by virtue of his conflict with the criminal justice system, rather than automatically being remanded to the state hospital for evaluation. The criteria used are legal rather than medical-psychiatric, and the evaluations are conducted by a mental health team consisting of a psychiatric social worker, a psychiatrist, and a psychologist. The authors describe the procedures and discuss the benefits deriving from them, as well as some of the real and potential problems.

Adult↗
PubMed1990

Monitoring insanity acquittees: Connecticut's psychiatric security review board.

In 1985 Connecticut established an administrative psychiatric security review board to monitor the postverdict disposition of defendants found not guilty by reason of mental disease or defect. The five-member board may confine an insanity acquittee in a mental hospital, grant temporary leave, order conditional release, and terminate confinement or conditional release. Judicial review is required before a patient is discharged from the board's custody. Between 1985 and 1989, a total of 173 insanity acquittees were under the board's jurisdiction; most were hospitalized in state psychiatric facilities. The authors discuss issues that must be addressed in creating a psychiatric security review board, including the conflict between protecting the public and treating insanity acquittees, clinicians' resistance to treating these patients, and problems posed by patients who do not appear to be mentally ill or who are well known to the public.

Adolescent↗
PubMed1992

Discrepancy compared to low achievement definitions of reading disability: results from the Connecticut Longitudinal Study.

We used data derived from a survey sample, the Connecticut Longitudinal Study (CLS), to compare two commonly employed definitions of reading disability: a discrepancy-based model (D) and a low reading achievement model (L). We identified children satisfying each definition in second grade and compared the groups retrospectively in kindergarten and prospectively in fifth grade using parent-based, teacher-based, and child-based measures. Our findings suggest more similarities than differences between the reading disabled groups. The most salient differences were those related to ability and seem inherent in the definitions of the groups: Children identified as D have significantly higher verbal, performance, and full scale IQ scores than those identified as L. These findings suggest that both groups of children with reading disability, that is, those defined by either D or L, should be considered eligible for special education services.

Achievement↗
PubMed2000

The status of prenatal care among Medicaid Managed Care patients in Connecticut.

Providing quality prenatal care to high-risk, pregnant adolescents represents an important challenge to health care providers and health plans. Using national prenatal care guidelines, this study sought to evaluate the quality of important processes and outcomes of prenatal care delivered to women age 21 years and younger enrolled in three health plans serving the Connecticut Medicaid population. Some important findings include 93% compliance with recommended processes of prenatal care, an 11% C-section rate, an average length of hospital stay of 4.0 days for women having a C-section, and a 10% premature delivery rate. Opportunities for improvement include 40% failing to begin prenatal care in the first trimester, 31% not receiving the recommended number of prenatal care visits, and 8% delivering a low-birth-weight infant. This study provides important descriptive information on processes and outcomes of care for pregnant adolescents within Medicaid Managed Care and also identifies opportunities for improvement.

Adolescent↗
PubMed1995

Resident selection in a Connecticut nursing home. A view from within.

Using data from a year of participant observation, this study provides a detailed description of resident selection procedures in a for-profit Connecticut skilled nursing facility. A system of multiple payers for nursing home services created a hierarchy of admission preferences that privileged those who could pay and denied access to the least profitable and the sickest individuals. Prescreening and waiting list juggling were strategies employed by the home to maximize the selection of private-paying residents and residents requiring the least care.

Connecticut↗
PubMedDate not supplied

The economic and social consequences of work-related musculoskeletal disorders: the Connecticut Upper-Extremity Surveillance Project (CUSP).

A population-based telephone survey was conducted in Connecticut to determine the social and economic impact of work-related musculoskeletal disorders (WRMSDs). Only 10.6% of cases had filed for workers' compensation. Respondents had spent an average of $489 annually out-of-pocket. Only 21% of individuals who had had medical visits or procedures reported having them paid for by workers' compensation. The WRMSD cases reported much higher levels of difficulty in daily tasks rated by the activities of daily living (ADL) scale, with odds ratios (ORs) ranging from 8.2 (child care) to 35.2 (bathing). The cases were significantly more likely to have moved for financial reasons (OR = 2.41), including having lost a home (OR = 3.44). The cases were also significantly more likely to have lost a car due to finances (OR = 2.45), more likely to have been divorced (OR = 1.91), and less likely to have been promoted (OR = 0.45). The study supports significant externalization of costs for WRMSD out of the workers' compensation system and a substantial social and economic impact on workers.

Activities of Daily Living↗
PubMed2004

"Getting the lead out" in Hartford, Connecticut: a multifaceted lead-poisoning awareness campaign.

As part of a citywide effort to increase lead poisoning awareness within the city of Hartford, Connecticut, the Hartford Health Department implemented a multifaceted public health campaign involving several novel elements and partnerships, including the use of municipal sanitation trucks to disseminate lead-poisoning prevention messages throughout the city. To evaluate campaign reach and effectiveness, Health Department personnel collected measures of lead-poisoning knowledge, recall of campaign components, and reports of steps taken to prevent lead poisoning from 180 largely ethnic minority parents of preschool-age children. Key results were as follows: a) Recall of campaign components ranged from 21.5 to 62.6%, with newspaper advertisements and signs on buses and billboards recalled most often and a video broadcast on public-access television recalled least often. b) More than 45% of respondents reported that they took steps to prevent lead poisoning because of at least one of the campaign components, with the newspaper advertisements being the most effective component in terms of prompting lead-poisoning prevention behavior. c) Respondents' awareness was particularly low in terms of how medical personnel and procedures can and cannot detect and prevent lead poisoning in children. This campaign prompted caregivers to take steps to prevent lead poisoning and may help public health professionals in other communities to develop novel ideas through which to embark on similar initiatives.

Adult↗
PubMed1984

Period and cohort factors in the incidence of malignant melanoma in the state of Connecticut.

The reasons for the increase in both incidence and mortality from malignant melanoma are not clear at this time, although there is an indication of a "generation effect" in the increasing frequency of the disease. The application of an age-period-cohort model to incidence data on malignant melanoma for the State of Connecticut indicate that, unlike mortality, the increase is almost entirely related to period factors. Two explanations are provided to explain this pattern of period factor increase. First, the increase in incidence could be artifically produced by better and earlier diagnosis. Second, a decrease in ozone level in the atmosphere may be responsible for the increase.

Adult↗
PubMed1998

Cloacal inoculation with the Connecticut strain of avian infectious bronchitis virus: an attempt to produce nephropathogenic virus by in vivo passage using cloacal inoculation.

Avian infectious bronchitis virus (IBV) strain Connecticut A-5968 isolated from respiratory tissue of chickens in USA in the 1960s, is considered as representative of respiratory disease causing IBV strains. Specific pathogen free chicks inoculated with the strain via the cloaca replicated the virus more rapidly in their kidneys than did chicks inoculated with the same virus intratracheally. Virus passaged thirteen-times via the cloaca caused stronger nephrotropism and nephropathogenicity than the parent virus. It is suggested that cloacal inoculation of IBV provides new and interesting information concerning the mechanisms of nephropathogenicity of IBV which has became increasingly important worldwide during the last ten years.

Animals↗