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PubMed1996

Birth-weight percentiles by gestational age, Connecticut 1988-1993.

Extreme birth weights are associated with increased infant mortality and morbidity. Identifying infants of extreme birth weight is important for both clinical assessment and public health research. This study aimed to produce charts of birth-weight percentiles by gestational age for male and female, black and white infants in Connecticut. Data were obtained from registrations of live births to Connecticut residents in Connecticut, 1988-1993. During this period 263,032 births were registered to black and white women. Birth weight was missing in only 90 records but gestational age was missing in 29,865 (11%) records. An additional 0.5% of births were excluded because the recorded birth weight was an extreme outlier for the recorded gestational age. Birth records with missing gestational age had lower mean birth weights and proportionately more births < or = 1500 g when compared to birth records where gestation was reported; however the magnitude of the differences was small. Our charts provide population-based birth-weight percentiles by gestational age based on the most recent Connecticut birth data available. They are the most appropriate population norms available for Connecticut clinicians and researchers.

Birth Weight↗
PubMed2000

Deliveries by family physicians in Connecticut: results of a practice-based research network.

OBJECTIVE: To obtain descriptive data on deliveries performed by family physicians in Connecticut during 1 year. DESIGN: All family physicians in Connecticut who provided obstetric care were personally contacted to enlist their participation in a research network. All such physicians agreed to participate and were instructed to mail a 15-item delivery data card to the author following each delivery that they participated in during calendar year 1996. MAIN OUTCOME MEASURES: Method of delivery, use of obstetric intervention (eg, oxytocin administration, episiotomy, and epidural anesthesia), and obstetric consultation rates. RESULTS: Thirty-two physicians, representing 9.0% of the family practice workforce in Connecticut, provided obstetric care. These 32 physicians, who practice in only 7 of the 31 acute care hospitals in the state, delivered 478 neonates during 1996. Most deliveries were by the spontaneous vaginal route, with forceps and vacuum used in 2.1% and 5.0% of vaginal deliveries, respectively. The primary cesarean section rate of these family physicians was low at 5.6% compared with a statewide rate for all providers (physicians and certified nurse midwives) of 12.4% (odds ratio, 0.42; 95% confidence interval, 0.28-0.63). Rates of certain obstetric interventions, such as oxytocin administration, epidural anesthesia, and episiotomy, varied greatly by hospital. Obstetric consultation rates also varied greatly among hospitals, ranging from 12.8% to 49.6%. CONCLUSIONS: Family physician involvement in maternity care in Connecticut is low. This study confirms a low rate of instrument-assisted and cesarean delivery in births attended by family physicians. Use of obstetric interventions and obstetric consultation varies greatly within the state.

Anesthesia, Epidural↗
PubMed1996

Time trend and age-period-cohort effect on incidence of bladder cancer in Connecticut, 1935-1992.

Earlier studies indicated that the incidence rates for bladder cancers rose rapidly in both the United States and Europe. Tobacco smoking is considered to be the major risk factor for urinary bladder cancer, and recent studies from Connecticut show that several smoking-related cancers have started leveling off or decreasing. The time trend for bladder cancer, however, is not clear in Connecticut. The current study examined the long-term trend of bladder cancer in Connecticut. Our results show that urinary bladder cancer has been increasing, with a marked increase among males. The rate of increase, however, has slowed since the early 1980s. Birth-cohort examination shows that the rates have leveled off for those born after about 1935 in both males and females. Age-period-cohort modeling results also show that the birth-cohort patterns of bladder cancer are somewhat similar to those observed for lung cancer in Connecticut, thus supporting the findings from analytical epidemiologic studies which indicate that cigarette smoking is one of the major risk factors for urinary bladder cancer. Our results also suggest that the difference in environmental and occupational exposures between males and females may be responsible for the large difference in the incidence rate of bladder cancer seen between the sexes.

Adult↗
PubMed1993

The time trend and age-period-cohort effects on incidence of adenocarcinoma of the stomach in Connecticut from 1955-1989.

BACKGROUND: Adenocarcinoma of the gastric cardia has been be increasing in Connecticut, and the risk factors responsible for the increasing incidence are unknown. This study examined the incidence pattern of adenocarcinoma of the gastric cardia and distal stomach in Connecticut during the past decades and identified components of birth cohort, period, and age as determinants of the observed time trends by regression modeling. METHODS: This study was based on all histologically confirmed incident cases of gastric adenocarcinoma reported to the Connecticut Tumor Registry between 1955 and 1989. Stomach cancers were grouped into cancers of the gastric cardia, distal stomach, or unknown/unspecified subsite. Age-adjusted incidence rates were calculated by the direct method standardized to the 1970 United States population. A regression model was used to identify birth cohort, period, and age as determinants of the observed time trends. RESULTS: The results indicated that the incidence rate of adenocarcinoma of the cardia is increasing, particularly in white males, whereas adenocarcinoma of the distal stomach is now decreasing in both sexes in Connecticut. Regression modeling suggests that the increase of adenocarcinoma of the cardia may be explained partly by a birth cohort phenomenon. CONCLUSION: There is little information regarding the risk factors that might be responsible for the observed increasing trend for adenocarcinoma of the cardia, although smoking, alcohol intake, retinol intake, and hiatal hernia have been associated with an increased risk of adenocarcinoma of the cardia or gastric cancer. Considering the different epidemiologic features of adenocarcinoma of the cardia and distal stomach, future analytic studies should separate cancer of the gastric cardia and cancer of the distal stomach in searching for etiologic factors.

Adenocarcinoma↗
PubMed2002

Geographic differences in invasive and in situ breast cancer incidence according to precise geographic coordinates, Connecticut, 1991-95.

To evaluate geographical variation of invasive and in situ breast cancer incidence rates using precise geographical coordinates for place of residence at diagnosis, latitude-longitude coordinates pertaining to 10,601 invasive and 1,814 in situ breast cancers for Connecticut women, 1991-95, were linked to US Census information on the 2,905 State census block groups. A spatial scan statistic was used to detect geographic excess or deficits in incidence and test the statistical significance of results, without prior assumptions about the size or location of such areas. The age adjusted invasive cancer incidence rate was 165.3/100,000 women/year. The spatial scan statistic identified 3 places with significantly low incidence rates and 4 places where rates were significantly high. The most probable location of low incidence was rural northeastern Connecticut where risk of disease, relative to elsewhere around the state, was 0.70 (p = 0.0001); the most probable place of elevated incidence was north central Connecticut where a relative risk of 1.34 (p = 0.002) was observed. Incidence of in situ disease was estimated to be significantly high for north central Connecticut (RR = 1.84; p = 0.0001). Geographic differences of invasive and in situ breast cancer incidence were observed. Examining cancer events at the lowest available level of data aggregation is beneficial in highlighting localized rate variations. Such information may enable public health officials to target additional resources for promoting breast cancer screening to specific locations.

Adult↗
PubMed1992

Histologic evaluation of pigmented lesions in Connecticut and its influence on the reporting of melanoma.

BACKGROUND: Underreporting of melanoma to state tumor registries has been identified as a problem in gathering accurate statistics on melanoma incidence. OBJECTIVE: Our purpose was to examine two factors that could influence the reporting of melanoma to the Connecticut Tumor Registry: histologic diagnosis of melanoma in the private offices of dermatologists and histologic diagnosis of melanoma in out-of-state laboratories. METHODS: From December 1990 to April 1991, questionnaires were sent to all known practicing dermatologists in the state of Connecticut (N = 149). Of the 127 dermatologists who were eligible, 124 (97.6%) completed the survey. RESULTS: The estimated number of melanomas diagnosed in private offices during 1990 was 9 to 18; this was based on the number of dermatologists who officially read their own slides (n = 19), the estimated number of melanomas diagnosed by these 19 dermatologists (n = 91), and the percentage of melanomas and uncertain pigmented lesion cases sent for consultation (80% to 90%). According to the estimates of Connecticut dermatologists, out-of-state laboratories diagnosed 84 of 523 melanomas (16%) in Connecticut residents. CONCLUSION: The diagnosis of melanoma in private offices did not appear to be a significant factor in underreporting whereas the diagnosis of melanoma in out-of-state laboratories did appear to be more significant. However, the possibility exists that some of these latter melanomas would eventually be reported at the time of reexcision.

Biopsy↗
PubMed1991

Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study.

An extensive epidemiologic study was undertaken in an attempt to analyze patterns of oral cancer distribution and demography in Connecticut between 1935 and 1985. Sources of data for the investigation included both the Connecticut Tumor Registry (CTR) and the University of Connecticut Oral Pathology Biopsy Service. During the 51-year study period, 9,708 cases of primary oral cancer were reported to the CTR. Male age-adjusted incidence rates for overall oral cancer remained stable between 1935 and 1964 (14.5 to 14.8 per 100,000), with a gradual decline to 10.9 per 100,000 in the early 1980s. In contrast, age-adjusted rates for females advanced approximately threefold, from 1.4 per 100,000 in the 1930s to 4.1 per 100,000 in the early 1980s. There was a decrease in age-specific rates of oral cancer in males aged 70 and older; in contrast, age-specific incidence rates in females increased steadily over the same period. It was also found that female birth cohorts born in 1900 and later exhibited higher oral cancer incidence rates than those of previous cohorts. Between the 1960s and the present, male patients 30 to 39 years of age exhibited a nearly fourfold increase in oral cancer incidence; this was not observed among similarly aged females. Connecticut counties with highest oral cancer incidence rates in both sexes were the more densely populated Hartford and New Haven counties. In general, the picture of oral cancer, as revealed through analysis of cases accessioned by the University biopsy service between 1975 and 1986, exhibited similar trends to those disclosed by analysis of CTR data.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Epidemiology of firearm mortality and injury estimates: state of Connecticut, 1988-1993.

STUDY OBJECTIVES: To retrospectively determine the 6-year cumulative incidence rate of firearm mortality and estimate nonfatal firearm injuries in Connecticut. METHODS: Retrospective analysis of data originating from the Connecticut State Medical Examiner's Office and records from the Trauma Registry of one urban hospital. RESULTS: From January 1988 through December 1993, 1,625 Connecticut residents died from firearm-related injuries. The cumulative incidence rate was 49.4 deaths per 100,000 population during the 6-year study period. Rates peaked among 20- to 24-year-olds at 18.1 deaths per 100,000. Males outnumbered females more than eightfold. The ratio of nonfatal firearm injuries to firearm deaths was 7:1 for those shot by another, self-inflicted injuries were fatal in half of all cases. CONCLUSION: Analysis of firearm mortality data indicated that males in younger age categories were disproportionately affected. These rates combined with nonfatal injury projections demonstrate that firearms represent a significant public health threat to the population of Connecticut, reaching epidemic proportions among specific subpopulations. These results are consistent with those obtained from national studies.

Adolescent↗
PubMed1995

An assessment of oral cancer underregistration at the Connecticut Tumor Registry.

The purpose of this study was to investigate whether and to what extent cases of oral cancer diagnosed through the University of Connecticut Health Center Oral Pathology Biopsy Service went unregistered by the Connecticut Tumor Registry during the period 1984 to 1988. All Oral Pathology Biopsy Service pathology reports generated from 1984 to 1988 were reviewed to identify diagnosed oral cancer cases (International Classification of Diseases, 9th revision codes 140, 141, 143 to 145). The names of all identified patients were computer-linked to previously registered cases. Nineteen (8.6%) of the 221 reportable cases of oral cancer diagnosed through the Oral Pathology Biopsy Service from 1984 to 1988 went unregistered. The 19 unregistered cases represented 1.6% of all known Connecticut oral cancer cases diagnosed during the period. The finding of a past, albeit small, "gap" in oral cancer cases registered with the Connecticut Tumor Registry suggests that oral pathologists should confirm that cases of oral cancer diagnosed through their pathology services are being registered by their regional tumor registries.

Connecticut↗
PubMed1999

Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system.

OBJECTIVE: To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut. DESIGN: Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics. SETTINGS: All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study. MAIN OUTCOME MEASURES: The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE. RESULTS: During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital. CONCLUSIONS: Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of iso lates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.

Adolescent↗
PubMed2004

Rethinking mental retardation: education and eugenics in Connecticut, 1818-1917.

This case study of mental retardation in Connecticut during 1818-1917 questions the existing model of interpretation. The discovery of mental retardation in Connecticut did not emanate from social fear over those who were different, difficult, or dangerous. Nor did state government initiate the institutionalization of the feeble-minded. Instead, Dr. Henry M. Knight, who founded the private Connecticut School for Imbeciles in 1858, was motivated by antebellum religious benevolence. His altruism was additionally motivated by cultural concerns to shape behavior according to middle-class, Protestant norms. By the end of the century, his son and successor Dr. George H. Knight departed from his father's emphasis on education and assimilation to embrace eugenics and segregation of the mentally retarded. Connecticut's pioneering marital ban (1895) and sterilization law (1909) were, however, virtually ineffective. Instead, the state sponsored in 1917 a large-scale custodial facility that sought to isolate the feeble-minded, whom reformers now portrayed as a menace to society. In sum, the Knights show a clear departure in policy between the first and second generation of administrators.

Attitude to Health↗
PubMed1997

Pesticide use by licensed applicators for the control of Ixodes scapularis (Acari: Ixodidae) in Connecticut.

To assess the use of insecticides for tick control by commercial applicators in Connecticut, a questionnaire was mailed to 897 individuals and businesses with ornamental and turf pesticide applicator licenses. In total, 348 completed surveys were returned (38.8%). The majority of the respondents considered themselves lawn care (41.1%), landscape (31.3%) or tree care (12.6%) providers. Tick control services were offered by 16.4% (n = 57) of the respondents, all of whom apply insecticides for tick control, mainly for Ixodes scapularis Say. Over half (n = 33) also treat for the American dog tick, Dermacentor variabilis (Say). Most respondents (66.7%) began applying pesticides for the control of I. scapularis during the period from 1990 to 1996. The principal acaricide used for tick control was cyfluthrin (n = 21), with chlorpyrifos 2nd (n = 18), carbaryl 3rd (n = 12), and fluvalinate (n = 4) 4th. When asked about what other pesticides were used for tick control, the top 3 chemicals also were the principal alternatives. Past success with a product was the dominant factor in selecting a pesticide, but information provided by the Connecticut Agricultural Experiment Station (New Haven), Cooperative Extension (University of Connecticut, Storrs), and scientific studies were important. Half of the respondents (49.1%) indicated that their tick control business had increased slightly or dramatically since 1991, although tick control comprises < 5% of their overall business for 63.1% of these applicators. Residential properties comprised 90% of the business for half of those treating for ticks, and the median charge for 0.4 ha was $180. Many respondents (43.8%) also indicated that they planned to expand their tick control services. Tick control represents a small but growing business in Connecticut.

Animals↗
PubMed2007

Early syphilis among men in Connecticut: epidemiologic and spatial patterns.

OBJECTIVE: The objective of this study was to describe the epidemiology of early syphilis among men in Connecticut, a moderate-prevalence region, in 2004. STUDY DESIGN: The authors conducted a cross-sectional analysis of health department data. RESULTS: Fifty-five cases were reported from 25 different towns. A majority of cases (82%) were reported among men who have sex with men, and 22% reported coinfection with HIV. Spatial analysis indicated moderate clustering of cases. Approximately half of 197 reported sex partners were not from Connecticut, including 28% from New York City and 20% from other states/countries. The median distance between partners was 48 km (30 miles). Twenty-three percent of syphilis cases had both local and nonlocal partners. CONCLUSIONS: The current epidemiology of early syphilis in Connecticut is consistent with national trends. However, the dispersal of cases throughout the state and the high proportion of reported sex partners residing outside of Connecticut suggest that this state is not a core area of endemic transmission.

Adult↗
PubMed1991

Geographical and temporal distribution of babesial infection in Connecticut.

Human babesiosis was first recognized in Connecticut in 1989, nearly 15 years after Lyme disease, a similarly transmitted spirochetosis, was detected in the state. To determine the seroprevalence for the babesial pathogen and whether it was recently introduced, we used an indirect immunofluorescence assay to test for Babesia microti antibody in 1,285 Connecticut residents. Four groups were studied: I, people seropositive for Lyme disease, tested from 1986 to 1989; II, randomly selected outpatients tested in 1989; III, college students residing in Connecticut, tested from 1959 to 1989; and IV, healthy people without tick exposure or Lyme disease, tested in 1989. Babesia seropositivity was significantly higher in group I (9.5%; n = 735) than in groups II (2.6%; n = 304, P less than 0.0001) and III (1.0%; n = 206, P less than 0.0001) but not group IV (2.5%, n = 40). Babesia seropositivity for group I ranged from 9.2 to 10.2% between 1986 and 1989, and Babesia seropositivity for group III ranged from 0% between 1959 and 1985 to 2.9% between 1986 and 1989. There is a considerable risk of babesial infection among residents of the Connecticut mainland who are seropositive for Lyme disease, a risk that appears to have remained constant over the past 5 years.

Animals↗
PubMed2002

Isolation of eastern equine encephalitis virus and West Nile virus from crows during increased arbovirus surveillance in Connecticut, 2000.

The emergence of the West Nile virus (WNV) in the northeastern United States has drawn emphasis to the need for expanded arbovirus surveillance in Connecticut. Although the state of Connecticut began a comprehensive mosquito-screening program in 1997, only since 1999 have there been efforts to determine the prevalence of arboviruses in bird populations in this state. Herein, we report on our results of an arbovirus survey of 1,704 bird brains. Included in this report are the first known isolations of eastern equine encephalitis virus (EEEV) from crows and data on the geographic and temporal distribution of 1,092 WNV isolations from crow species. Moreover, these nine isolations of EEEV identify regions of Connecticut where the virus is rarely found. With the exception of WNV and EEEV, no other arboviruses were isolated or detected. Taken together, these data illustrate the distribution of avian borne EEEV and WNV in 2000 and support the need for ongoing avian arbovirus surveillance in Connecticut.

Animals↗
PubMed2000

Occupational disease in Connecticut, 2000.

This study was designed to establish the magnitude and distribution of reported occupational diseases in Connecticut based on 1998 data. Occupational disease is a reportable disease in Connecticut, yet is under-reported particularly for chronic conditions. The number of reported occupational diseases was 3,556 from workers' compensation reports, 1,444 from physician reports, and 5,510 from the Connecticut OSHA-Labor Department survey. Musculoskeletal disorders dominate the reports in all three databases, ranging from 46% to 62% of all illness reports. Skin conditions range from 8% to 18%; lung conditions from 9% to 16%; and infections from 1% to 18%. There are approximately 1.52 million workers in Connecticut, which results in a rate of 36.2 cases of occupational disease per 10,000 workers based on the Bureau of Labor Statistics figures. These conditions are broken down by type, industry, and cause. Improved identification of work linkages can lead to better treatment and job placement, as well as improved prevention.

Connecticut↗
PubMed2005

Tracking racial and ethnic disparities of knee replacement rates in Connecticut.

OBJECTIVE: Determine knee replacement rates among white, black, and Hispanic men and women in Connecticut. METHODS: Connecticut population estimates and hospital discharge data were obtained. Race and ethnicity were identified by hospital personnel. Connecticut residents with knee replacement (ICD-9-CM 81.54) in any of 10 procedure fields were included. Rates were age-adjusted to the U.S. 2000 population. RESULTS: 1996-1998 age-adjusted knee replacement rates per 100,000 population aged 25 and older were significantly higher among black women (115.8, 95% confidence interval 103.9-127.7) than white women (84.9, 82.4-87.4), significantly higher among white men (66.4, 63.9-68.9) than black men (44.0, 34.9-53.1), and lowest among Hispanic men (16.9, 10.1-23.7) and women (47.5, 37.8-57.2). CONCLUSION: Inferences about disparities cannot be drawn, although Connecticut data are consistent with no disparity between the knee replacement rate in black women relative to white women. Data about symptomatic knee osteoarthritis are needed. Patient and physician treatment preferences must be considered.

Adult↗
PubMed1989

Eastern equine encephalitis in Quebec and Connecticut, 1972: introduction by infected mosquitoes on the wind?

In 1972 there were outbreaks of eastern equine encephalitis in the Eastern Townships, Quebec, Canada and in Connecticut, USA. Climatic data including Northern Hemisphere synoptic charts were examined. The findings indicate that the virus could have been brought to Lac Brome by infected mosquitoes carried on surface winds from Meriden, Connecticut, on the night of August 22-23, 1972. The distance of 400 km would have been covered in 14-16 h at a speed of 25-30 km h-1 and at a temperature of 15 degrees C and higher. The first case was recorded 13 days later on September 5, 1972. The outbreak at Meriden, Connecticut started on August 21, 1972. On August 7, 1972 southwesterly winds blew along the Atlantic coast at heights up to 1.5 km. Infected mosquitoes could have been carried on the wind from Cape May, New Jersey, Delaware-Maryland-Virginia peninsula, North Carolina or Georgia. Flights would have been at 17 degrees-20 degrees C and lasted 5-6, 9-10, 14-16 and 20-26 h depending on the origin. The arrival on August 8, 1972 coincided with a cold front moving from the northwest through Connecticut. Culiseta melanura is regarded as the mosquito species most likely to have been involved in the transmission of infection.

Air Movements↗