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PubMed1981

Pulmonary function loss in Vermont granite workers. A long-term follow-up and critical reappraisal.

Previous studies of Vermont granite workers averred that pulmonary function loss was occurring at 2 to 3 times the normal rate. The excess loss was attributed to the current, relatively low concentrations of dust prevailing in the stone sheds. Because the Vermont State Health Department had traditionally provided surveillance of granite workers to detect evidence of occupationally related illness, we offered pulmonary function screening to any currently employed worker. Spirometric data from the first 150 workers, compared with data from the previous studies, showed a large increase in the FVC and a smaller increase in the FEV1. We therefore undertook a survey of the entire stone shed work force, as well as of retired workers tested previously. The results in 487 current workers indicated an overall increase in FVC from 1974 to 1979 of 0.540 L, and an increase in FEV1 of 0.030 L: predicted losses based on the previous studies were 0.350 to 0.400 L in FVC and 0.250 to 0.350 L in the FEV1. Analysis of data in various subgroups, such as retired workers or those with more than 20 yr of work experience, also showed increases in FVC, and either slight gains or minimal losses in FEV1. The possible reasons for apparent improvement in pulmonary function are discussed. We concluded that technical deficiencies in the previous studies led to exaggerated and erroneous estimates of loss. At this time, the actual decrement in pulmonary function values for exposed granite workers is not known and requires further investigation. Because the newly proposed, stricter standard, for silica was importantly influenced by the previous studies, we believe that adoption of this standard would be premature.

Air Pollutants↗

PubMed2006

Intra-cluster correlation coefficients in adults with diabetes in primary care practices: the Vermont Diabetes Information System field survey.

BACKGROUND: Proper estimation of sample size requirements for cluster-based studies requires estimates of the intra-cluster correlation coefficient (ICC) for the variables of interest. METHODS: We calculated the ICC for 112 variables measured as part of the Vermont Diabetes Information System, a cluster-randomized study of adults with diabetes from 73 primary care practices (the clusters) in Vermont and surrounding areas. RESULTS: ICCs varied widely around a median value of 0.0185 (Inter-quartile range: 0.006, 0.037). Some characteristics (such as the proportion having a recent creatinine measurement) were highly associated with the practice (ICC = 0.288), while others (prevalence of some comorbidities and complications and certain aspects of quality of life) varied much more across patients with only small correlation within practices (ICC<0.001). CONCLUSION: The ICC values reported here may be useful in designing future studies that use clustered sampling from primary care practices.

Adult↗

PubMed2004

The Vermont Diabetes Information System (VDIS): study design and subject recruitment for a cluster randomized trial of a decision support system in a regional sample of primary care practices.

BACKGROUND: Despite evidence that optimal care for diabetes can result in reduced complications and improved economic outcomes, such care is often not achieved. The Vermont Diabetes Information System (VDIS) is a registry-based decision support and reminder system based on the Chronic Care Model and targeted to primary care physicians and their patients with diabetes. PURPOSE: To develop and evaluate a regional decision support system for patients with diabetes. METHODS: Randomized trial of an information system with clustering at the practice level. Ten percent random subsample of patients selected for a home interview. SUBJECT: and setting includes 10 hospitals, 121 primary care providers, and 7348 patients in 55 Vermont and New York primary care practices. RESULTS: We report on the study design and baseline characteristics of the population. Patients have a mean age of 63 years and a mean glycosolated hemoglobin A1C of 7.1 %. Sixty percent of the population has excellent glycemic control (A1 C < 7%); 45% have excellent lipid control (serum LDL-cholesterol <100 mg /dL and serum triglycerides <400 mg/dL). Twenty-five percent have excellent blood pressure control (<130/80mmHg). These results compare favorably to recent national reports. However, only 8% are in optimal control for all three of hyperglycemia, lipids and blood pressure. CONCLUSIONS: Our experience to date indicates that a low cost decision support and information system based on the Chronic Care Model is feasible in primary care practices that lack sophisticated electronic information systems. VDIS is well accepted by patients, providers and laboratory staff. If proven beneficial in a rigorous, randomized, controlled evaluation, the intervention could be widely disseminated to practices across America and the world with a substantial impact on the outcomes and costs of diabetes. It could also be adapted to other chronic conditions. We anticipate the results of the study will be available in 2006.

Adolescent↗

PubMed1995

The Maine and Vermont three-decade studies of serious mental illness. II. Longitudinal course comparisons.

BACKGROUND: This paper supplements the cross-sectional outcome comparisons of the companion paper by providing a brief account of the longitudinal courses of the Maine and Vermont samples across several outcome domains. METHOD: A Life Chart method was used to document changes in individual lives over the domains of residence, work, income source, and use of community resources over a 20-year period. Reliability studies between states were conducted. RESULTS: Throughout much of the period, more Vermont subjects lived independently, were working, and were less likely to use community resources compared to Maine subjects. CONCLUSIONS: Differences in both policies and programmes contributed to course differences between the groups. System characteristics that may lead to better outcomes are discussed.

Activities of Daily Living↗

PubMed2005

In search of a more perfect heteroarchy:Vermont, civil unions and the harm of "separate-but-equal".

This article focuses on the Vermont civil union solution to the state Supreme Court's mandate in Baker v. State (1999). Using non-subordination theory, the author argues that rather than being a legal victory for lesbians and gay men, the Vermont law integrally contributes to the maintenance of an imbalance of power between heterosexuals and lesbians and gays. The article analyzes the rhetorical strategy employed by lawmakers to respond to what they perceived and portrayed as a menace posed by same-sex marriage and demonstrates that lawmakers reinforced apprehensions surrounding lesbian and gay identity and asserted the familiar heterosexist narrative in an effort to quell the threat posed by Baker. The article concludes that the legislature's genuine motivation behind civil unions was validating their own and their constituents' misplaced fears regarding gay and lesbian identity, and pacifying those fears by denying equal marriage rights to gays and lesbians in an attempt to appear responsive to a perceived threat to heterosexual primacy.

Female↗

PubMed1991

Radiographic abnormalities in Vermont granite workers exposed to low levels of granite dust.

The issue of whether low levels of granite dust exposure lead to radiographic abnormalities after a lifetime of exposure has not been settled. In 1983, we carried out a radiographic survey of the Vermont granite industry, consisting of quarry and stone shed workers who had been exposed to the low dust levels prevailing in the industry since 1938 to 1940. Films were read by three "B" readers, using the ILO classification system, which requires the identification of both rounded and irregular opacities, as well as combinations of both. X-ray films were taken of 972 workers, out of a total work force of approximately 1,400. Of these films, 28 (3 percent) were interpreted by either two or three of the three readers as showing abnormalities consistent with pneumoconiosis. Only seven films (or 0.7 percent of the entire cohort) showed nodular or rounded opacities of the type typically seen in uncomplicated silicosis. The remainder of the abnormal x-ray films showed irregular opacities, largely in the lower lung zones, which are of uncertain significance, but may be related to heavy cigarette smoking and aging, and possibly dust inhalation. In addition, total gravimetric dust concentrations in the workplace were measured; 417 respirable-size mass samples showed concentrations of 601 micrograms/cu m +/- 368 micrograms/cu m. Using previously published estimates of 10 percent quartz in granite dust, the average quartz concentration was 60 micrograms/cu m. Twelve percent of the samples exceeded 100 micrograms/cu m, the current OSHA standard for quartz. We conclude that control of quartz exposure in the Vermont granite industry to levels which are on average less than the current OSHA standard has essentially eliminated definite radiographic changes of silicosis. The significance of the irregular opacities in the lower lung zones seen on a majority of the 28 x-ray films judged to be abnormal is not clear.

Adult↗

PubMed2006

Reduction of bronchopulmonary dysplasia after participation in the Breathsavers Group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative.

OBJECTIVE: The objective of this study was to compare the primary and secondary outcomes of very low birth weight infants before and after participation in the Breathsavers Group of the Vermont Oxford Network-sponsored Neonatal Intensive Care Quality Collaborative. METHODS: Hospitals that participated in the Breathsavers Group contributed clinical data on the outcomes of their very low birth weight infants to the Vermont Oxford Network using standardized clinical definitions, data forms, and inclusion criteria. Outcomes from the last year of the collaborative, 2003, were compared with those from the baseline year, 2001. Models for treatment practices and outcomes measures were adjusted for within-hospital correlation (clustering) and standard risk factors that were present at birth. RESULTS: Bronchopulmonary dysplasia dropped significantly in 2003 compared with the baseline year. Survival improved but not significantly. In addition, severe retinopathy of prematurity, severe intraventricular hemorrhage, and supplemental oxygen at discharge dropped significantly. The use of conventional ventilation at any time during the initial hospitalization, postnatal steroids, and time to first dose of surfactant all decreased significantly. The use of nasal continuous positive airway pressure at any time during hospitalization increased. The use of high-frequency ventilation, delivery room intubation, and surfactant at any time during hospitalization did not change. CONCLUSIONS: The Breathsavers Group improved both clinical care processes and clinical outcomes during the Neonatal Intensive Care Quality Collaborative.

Adrenal Cortex Hormones↗

PubMed2004

Assessment of mercury in waters, sediments, and biota of New Hampshire and Vermont Lakes, USA, sampled using a geographically randomized design.

We report on mercury (Hg) contamination in waters, sediments, and biota of Vermont and New Hampshire (USA) lakes measured during 1998-2000, using a geographically randomized design. Waters and sediments of 92 lakes were sampled for mercury, methylmercury, and ancillary parameters. Yellow perch (Perca flavescens) muscle tissues were analyzed for mercury on 47 of these lakes. Interannual variation in mercury was limited; only epilimnetic Hg was elevated by approximately 1.5 ng/L in 1998 over remaining years because of wet weather. Aqueous total and methylmercury concentrations were elevated in both dystrophic and eutrophic lakes over other types. Yellow perch tissue concentrations were elevated by 0.218 microg/g in dystrophic lakes over other types and were very low in eutrophic lakes. Fish tissue mercury concentrations showed no relationship to hypolimnetic or sediment mercury or methylmercury. A statistical model indicated that yellow perch tissues in 40.2 +/- 13% of lakes were likely to exceed the U.S. Environmental Protection Agency (U.S. EPA) methylmercury criterion of 0.3 microg/g, and yellow perch from New Hampshire were twice as likely to exceed the criterion as those from Vermont. Results of this study provide a regional-scale baseline against which the success of future reductions in mercury emissions can be assessed.

Age Factors↗

PubMed2006

Diabetes decision support: initial experience with the Vermont diabetes information system.

Interventions that have proven effective in the management of chronic illness have often been difficult to establish in widespread practice. The Chronic Care Model provides a framework for implementing interventions, but it is expensive and difficult to implement. We developed a decision support system based on this model to improve the care of adults who have diabetes and receive primary care in Vermont or adjacent New York. The Vermont Diabetes Information System uses a network of community laboratories for providing data to produce flowsheets, reminders, action alerts, and population reports that are sent to primary care providers by fax and to patients by mail. Currently, 7295 patients are cared for by 124 primary care providers in 62 practices and are enrolled in a randomized controlled trial to study its effects.

Albuminuria↗

PubMed2001

Evaluation of a child sexual abuse prevention program--Vermont, 1995-1997.

Public health social marketing campaigns have targeted adults to prevent drinking and driving, smoking, and human immunodeficiency virus transmission; however, adults have not been targeted for prevention of child sexual abuse. In Vermont, STOP IT NOW! addresses child sexual abuse systematically as a public health issue by using social marketing and public education to emphasize the responsibility of adults for prevention. As one component of STOP IT NOW!, Vermont sex offender treatment providers and state attorneys' offices were surveyed in September 1997 to assess self-reported abuse by adults and adolescents. This report summarizes the results of the survey, which indicate that some adults who abuse will turn themselves in voluntarily for treatment despite mandated reporting to the legal system, and some parents will intervene to seek help for their children who have sexual behavior problems even without a victim's report. Continued studies are needed to evaluate this approach to preventing child sexual abuse.

Child↗

PubMed1992

The modeling of breast cancer deaths in Vermont.

Methodologic issues in modeling breast cancer deaths were investigated through modeling the number of breast cancer deaths in Vermont for the period 1975 to 1988. Age-specific incidence rates, case fatality rates, and secular trends of these rates were necessary to represent the observed trend in breast cancer deaths over this time period. Additional information, such as mortality from other causes, stage distribution, or screening history, was not necessary. Incidence and survival information were obtained from a statewide population-based breast cancer registry in Vermont and the Surveillance, Epidemiology and End Results (SEER) program. SEER incidence rates overestimated the actual number of deaths for long-term survival rates. Case fatality rates and secular trends in incidence and survival reported by SEER were appropriate. These results can be applied to the planning of community intervention studies by providing the essential expected numbers of deaths in control communities.

Adult↗

PubMed1992

Tetanus--Rutland County, Vermont, 1992.

In July 1992, the Vermont Department of Health received a report of a case of tetanus. The last reported case of tetanus in Vermont was in 1987. This report summarizes the case investigation.

Adult↗

PubMedDate not supplied

Educational program evaluation: the University of Vermont family nurse practitioner program.

Graduates of the Family Nurse Practitioner (FNP) Program at the University of Vermont, Burlington, were surveyed to determine if the FNPs had enlarged their nursing roles following completion of the program. A sample of Vermont nurses served as a control group. Results of a questionnaire, used to obtain information about the nurses' training, functions, and attitudes, indicated that FNPs performed activities associated with an expanded nursing role more frequently than did their nonpractiioner counterparts. There was evidence that the two groups differed in their attitudes toward various aspects of their nursing roles. The evaluation is an ongoing study; as the number of program graduates increases, further characterization of their roles will be possible.

Attitude of Health Personnel↗

PubMedDate not supplied

AIDS knowledge and attitudes among adults in Vermont.

To design a statewide educational campaign, the Vermont Department of Health attempted to measure knowledge about AIDS among residents of the State. During the period November 1986 through January 1987, the authors conducted a telephone survey of noninstitutionalized residents ages 18 and over. The results were examined in relation to age and education. The most accurate answers were given by respondents less than 45 years. In terms of educational attainment, respondents with less than a high school education had an average score of 61.4 and those with a college degree averaged 85.0. When the authors examined responses to individual questions, it became apparent that respondents were more knowledgeable about ways the virus could be transmitted than about ways it could not. A more comprehensive education program must reduce fear. One component of the current AIDS campaign in Vermont is an advertisement that addresses unfounded concern about casual transmission of AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Carbon monoxide poisoning associated with a propane-powered floor burnisher--Vermont, 1992.

On July 28, 1992, two employees of a pharmacy in Vermont fainted within four hours after arriving for work; at a local hospital emergency department, carbon monoxide (CO) poisoning was diagnosed based on elevated carboxyhemoglobin (HbCO) levels. The pharmacy was evacuated, and the remaining eight employees were transported to the hospital for evaluation. Further investigation by the Vermont Department of Health (VDH) revealed that, on July 24, one of the employees had fainted, but CO poisoning was not suspected, and vasovagal syncope was diagnosed. This report summarizes the investigation of these cases by VDH.

Adolescent↗

PubMedDate not supplied

Rabies in New Hampshire and Vermont: an update.

New Hampshire and Vermont currently have two rabies epizootics occurring in raccoon and fox populations. These are continuations of the established raccoon strain which has been migrating northward from the mid-Atlantic and the fox strain which is migrating south and eastward from Canada and New York. These started in the early 1990s, and the wild animal cases have increased from 0 to 1 case per year in Vermont in the late 1980s to 179 in 1995, and from 0 to 4 cases in New Hampshire to 152 in 1995. Since 1992 there has been a slight increase in domestic animal cases, but no human cases have been reported. The cost of prophylaxis and animal testing has greatly increased, including one episode where 665 persons were exposed to a rabid kitten and underwent postexposure prophylaxis at an estimated cost of $1.5 million. This paper gives epidemiologic data for the two states and reviews the current literature to discuss history, clinical features, testing, postexposure prophylaxis, and treatment of rabies.

Animals↗

PubMed1995

Winter photosynthesis of red spruce from three Vermont seed sources.

We evaluated winter (January through March) carbon assimilation of red spruce (Picea rubens Sarg.) from three Vermont seed sources grown in a common garden in northwestern Vermont. Although CO(2) exchange rates were generally low, net photosynthetic rates increased during two prolonged thaws. Significant correlations between CO(2) exchange rates and multiday air temperature means supported our observations of enhanced gas exchange during extended periods of elevated temperature. Increases in photosynthesis during thaws occurred before observed increases in leaf conductance, indicating that initial changes in photosynthesis were probably not associated with changes in stomatal aperture. Results of correlations between photosynthetic rates and PAR suggested that solar irradiance did not have a strong effect on winter carbon capture. Rates of net photosynthesis differed among seed sources. Trees from the Mt. Mansfield source had the highest average rates of photosynthesis and, at times, rates for individual trees from this source approximated those occurring during the growing season. Because seed sources differed in photosynthetic rates but not in leaf conductance, we conclude that differences in winter photosynthesis among seed sources were primarily attributable to factors other than changes in stomatal aperture.

Journal Article↗

PubMed1994

Longitudinal pulmonary function losses in Vermont granite workers. A reevaluation.

Previous studies have suggested that excessive losses of FVC and FEV1 were occurring in Vermont granite workers despite the fact that mean quartz levels existing in the industry were below the current OSHA standard of 100 micrograms/m3. We reexamined these losses in granite workers over an 8-year period, testing the workforce biennially from 1979 to 1987. All workers, including stone shed, quarry, and office, were offered forced spirometry using a 10-L water-sealed spirometer (Collins). In the peak year of participation (1983), 887 workers out of a total of approximately 1,400 were tested. Estimates of longitudinal loss were based on 711 workers who participated in at least three of the surveys. The mean age of this group was 42.9 years, and the mean years employed was 19.3 years; 21.4 percent were non-smokers (NS), 34.2 percent were ex-smokers (ES), and 44.4 percent were current smokers (CS). Average annual losses of FVC were 0.018 (SD = 0.056) L (CS, 0.025 L; NS, 0.006 L: and ES, 0.016 L). Average annual losses of FEV1 were 0.030 (SD = 0.041) L (CS, 0.038 L; NS, 0.020 L; and ES, 0.027 L). Analysis of covariance indicated that losses were related to the initial values for FVC or FEV1, height, age, and smoking status. After adjusting for these variables, the losses of both FVC and FEV1 were not correlated with years employed in the granite industry. No significant differences existed in the loss of FVC or FEV1 in categories of workers exposed to different levels of granite dust, eg, office, quarry, and stone shed workers. The annual losses of pulmonary function were significantly smaller than those estimated previously, which were 0.070 to .080 L in FVC, and 0.050-0.070 L in FEV1. We conclude that dust levels in the Vermont granite industry, which have been in conformance with OSHA permissible exposure limits, do not accelerate pulmonary function loss.

Adult↗