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PubMed1993

Sensitization and exposure to indoor allergens as risk factors for asthma among patients presenting to hospital.

To investigate the role of indoor allergens in adult patients with acute asthma, we conducted a case-controlled study on patients presenting to an emergency room. One hundred and fourteen patients and 114 control subjects were enrolled over a 1-yr period in Wilmington, Delaware. Sera were assayed for total IgE, and for IgE antibodies to dust mites, cat dander, cockroach, grass pollen, and ragweed pollen. Dust was obtained from 186 homes and assayed for dust mite, cat, and cockroach allergens. IgE antibodies to mite, cat, and cockroach were each significantly associated with asthma, and this association was very strong among participants without medical insurance and among African Americans. Among 99 uninsured participants, sensitization to one of the indoor allergens (> 200 RAST units) was present in 28 of 57 asthmatics and in one of 42 control subjects (odds ratio, 39; confidence interval, 9.4 to 166). For cat and cockroach the combination of sensitization and presence of allergen in the house was significantly associated with asthma. Furthermore, there was a strong inverse relationship between IgE antibodies to cat and to cockroach, and the risk of this sensitization was in large part restricted to homes or areas with high levels of allergen. Thirty-eight percent of the asthmatics, but only 8% of the control subjects, were allergic to one of the three indoor allergens, and had high levels of the relevant allergen in their houses (odds ratio, 7.4; confidence interval, 3.3 to 16.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Increasing illness severity in very low birth weight infants over a 9-year period.

BACKGROUND: Recent reports have documented a leveling-off of survival rates in preterm infants through the 1990's. The objective of this study was to determine temporal changes in illness severity in very low birth weight (VLBW) infants in relationship to the outcomes of death and/or severe IVH. METHODS: Cohort study of 1414 VLBW infants cared for in a single level III neonatal intensive care unit in Delaware from 1993-2002. Infants were divided into consecutive 3-year cohorts. Illness severity was measured by two objective methods: the Score for Neonatal Acute Physiology (SNAP), based on data from the 1st day of life, and total thyroxine (T4), measured on the 5th day of life. Death before hospital discharge and severe intraventricular hemorrhage (IVH) were investigated in the study sample in relation to illness severity. The fetal death rate was also investigated. Statistical analyses included both univariate and multivariate analysis. RESULTS: Illness severity, as measured by SNAP and T4, increased steadily over the 9-year study period with an associated increase in severe IVH and the combined outcome of death and/or severe IVH. During the final 3 years of the study, the observed increase in illness severity accounted for 86% (95% CI 57-116%) of the variability in the increase in death and/or severe IVH. The fetal death rate dropped from 7.8/1000 (1993-1996) to 5.3/1000 (1999-2002, p = .01) over the course of the study. CONCLUSION: These data demonstrate a progressive increase in illness in VLBW infants over time, associated with an increase in death and/or severe IVH. We speculate that the observed decrease in fetal death, and the increase in neonatal illness, mortality and/or severe IVH over time represent a shift of severely compromised patients that now survive the fetal time period and are presented for care in the neonatal unit.

Birth Weight↗
PubMed2004

Developing local public health capacity in cultural competency: a case study with Haitians in a rural community.

With the increase in cultural diversity in all regions of the United States, public health employees and other health care providers are more challenged than ever before to provide culturally sensitive care to citizens from an increasing range of cultures. Building on their existing experience and skill, health care staff must expand their competencies to address this changing diversity in their communities. This project serves as a case study of how 1 small rural health department in Delaware created a Web site using Purnell's model for cultural competence (Purnell & Paulanka, 2003) as the organizational framework and rose to the challenge of assisting public health staff to provide culturally sensitive health services to a rapidly increasing population of Haitian immigrants.

Adult↗
PubMed1981

The 1960s epidemic of arthrogryposis multiplex congenita: a survey from the United Kingdom, Australia and the United States of America.

Arthrogryposis multiplex congenita is believed to be a specific clinical entity which is aetiologically unrelated to the "arthrogryposis-like" deformities of known neurological diseases such as myelomeningocele and myelodysplasia. The observation that the condition appeared to be three times as common in Melbourne, Australia, as in four centres in the United Kingdom (Wynne-Davies and Lloyd-Roberts 1976), prompted this survey of 132 patients: 73 from the United Kingdom, 34 from Australia and 25 from Wilmington, Delaware, USA. The survey aimed to established the same criteria for diagnosis in the three countries and to search for prenatal and genetic aetiological factors. It was shown that all centers treated more newborn children with this disorder during the 1960s than either before or after that period. All cases were sporadic and there was no family association with talipes equinovarus, congenital dislocation of the hip or hereditary neuromuscular disease. "Environmental" findings from all three centers were similar and it was concluded that arthrogryposis multiplex cogenita is a non-genetic disease of early pregnancy, associated with a variety of unfavourable intra-uterine factors. In addition, an unknown but possibly viral environmental agent may have been present to a significant extent only during recent decades and is now declining.

Abnormalities, Multiple↗
PubMed1988

Sensitivity and specificity of clinical case definitions for pertussis.

We evaluated the diagnostic performance of 15 clinical case definitions for pertussis in 233 patients who developed acute respiratory illness during community outbreaks in Wisconsin and Delaware. Using results from culture (Regan-Lowe media) and serology (Ig-class-specific ELISA) as diagnostic standards, cough for greater than or equal to 14 days was both sensitive (84 per cent-92 per cent) and specific (63 percent-90 per cent) in identifying patients with pertussis. This definition may be useful in monitoring pertussis outbreaks and for investigating contacts of culture-positive cases.

Adolescent↗
PubMed1998

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

OBJECTIVES: This study examined the effect of continuity with clinicians and health care sites on likelihood of future hospitalization. METHODS: Delaware Medicaid patient data were analyzed. Logistic regression models supplied adjusted effects of continuity on hospitalization. RESULTS: Patients in the high clinician continuity group had lower odds of hospitalization than patients in the high site/low clinician continuity group (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.66, 0.87). The latter group did not differ from the low site/low clinician continuity group (OR = 0.93, 95% CI = 0.80, 1.08). CONCLUSIONS: A location providing health care without clinician continuity may not be sufficient to ensure cost-effective care.

Adolescent↗
PubMed2001

The impact of referral to a primary physician on cervical cancer screening.

OBJECTIVES: The purpose of this study was to determine whether referral to a primary physician led to an increase in screening for cervical cancer among women enrolled in Delaware Medicaid. METHODS: Medicaid claims data were used to compare annual Papanicolaou (Pap) test rates for women referred to a primary care physician or obstetrician (n = 365) with rates for age-matched comparison women who were not referred (n = 1799). RESULTS: Thirty-eight percent of referred women and 27% of comparison women underwent Pap tests (adjusted odds ratio = 1.71; 95% confidence interval = 1.33, 2.20). CONCLUSIONS: Referral to a primary physician had a positive impact on cervical cancer screening among the study participants.

Adolescent↗
PubMed1998

The descriptive epidemiology of craniopharyngioma.

OBJECT: In this report the authors describe the epidemiology of craniopharyngioma. METHODS: The incidence of craniopharyngioma in the United States was estimated from two population-based cancer registries that include brain tumors of benign and borderline malignancy: the Central Brain Tumor Registry of the United States (CBTRUS) and the Los Angeles county Cancer Surveillance Program. Information on additional pediatric tumors was available from the Greater Delaware Valley Pediatric Tumor Registry (GDVPTR). The overall incidence of craniopharyngioma was 0.13 per 100,000 person years and did not vary by gender or race. A bimodal distribution by age was noted with peak incidence rates in children (aged 5-14 years) and among older adults (aged 65-74 years in CBTRUS and 50-74 years in Los Angeles county). Survival information was available from GDVPTR and the National Cancer Data Base (NCDB), a hospital-based reporting system. In the NCDB, the 5-year survival rate was 80% and decreased with older age at diagnosis. Survival is higher among children and has improved in recent years. CONCLUSIONS: Craniopharyngioma is a rare brain tumor of uncertain behavior that occurs at a rate of 1.3 per million person years. Approximately 338 cases of this disease are expected to occur annually in the United States, with 96 occurring in children from 0 to 14 years of age.

Adolescent↗
PubMed1991

Nursing education, practice, and professional identity: a transcultural course in England.

Students from a baccalaureate program at the University of Delaware participated in a 4-week course in England, exploring nursing's role in the health care system of that country. Students observed and interacted with a variety of clients and nurses in diverse settings; they observed similarities and differences in nursing education, practice, and professional identity between nurses in England and in the United States. The course was timely and valuable--it provided students with the opportunity to enhance their awareness of another culture and it allowed them to recognize nursing's importance in global health concerns.

Attitude of Health Personnel↗
PubMed1978

Natural transmission of Keystone virus to sentinel rabbits on the Delmarva Peninsula.

Domestic rabbits were exposed in the Pocomoke Cypress Swamp from early May through October 1973, to act as sentinel indicators of Keystone (KEY) virus transmission on the Delaware-Maryland-Virginia (DelMarVa) Peninsula. Rabbits were bled weekly and their sera were tested for the presence of neutralizing antibody to both KEY and James-town Canyon (JC) viruses. Adult mosquito activity was monitored concurrently by CDC miniature light traps with Dry Ice. Of 100 rabbits exposed, 20 rabbits acquired neutralizing antibody to KEY virus as a result of their exposure; none acquired antibody to JC virus. Eighty-three percent of susceptible rabbits exposed converted immediately after the emergence of Aedes atlanticus adult mosquitoes in early September. Rabbit seroconversions were not limited to any particular habitat within the swamp. The conversion of a large proportion of sentinel rabbits immediately following emergence of A. atlanticus, and the previous demonstration of transovarial transmission of KEY virus by A. atlanticus, suggest that vertically infected individuals are capable of viral transmission at their initial engorgement. Such transmission provides the initial step in a vertebrate amplification cycle.

Aedes↗
PubMed1982

Serologic evidence of Jamestown Canyon and Keystone virus infection in vertebrates of the DelMarVa Peninsula.

Serological data accumulated during the past decade indicated that a variety of feral and domestic animals of the Delaware-Maryland-Virginia (DelMarVa) Peninsula were infected with Jamestown Canyon (JC) and/or Keystone (KEY) viruses (Bunyaviridae, California serogroup). Neutralizing (N) antibody to JC virus was most prevalent in white-tailed deer, sika deer, cottontail rabbits and horses. KEY virus N antibody was detected most frequently in gray squirrels and domestic goats. N antibody indicative of past infection by one or both viruses also was found in raccoons, horses and humans. JC and/or KEY virus N antibodies were not demonstrable in sera of several other species of small mammals and reptiles. Investigations were extended to evaluate the role of domestic goats as an amplifying host of JC and KEY viruses and to assess their potential as sentinels of virus transmission. Goats maintained in the Pocomoke Cypress Swamp during the summer season of 1978, acquired N antibodies to JC and KEY viruses. Following experimental inoculation with either JC or KEY virus, all goats developed N antibody despite the absence of a demonstrable viremia in most animals. Goats proved to be effective as sentinels for monitoring the transmission of JC and KEY viruses; however, the exceptionally low titers or absence of viremia following inoculation with these viruses would seem to preclude a potential virus-amplifying role for this species. Although findings implicated primarily gray squirrels and white-tailed deer as possible amplifying hosts of KEY and JC virus, respectively, further investigations will be required to clarify their role, particularly since both viruses may be maintained entirely by transovarial transmission.

Aedes↗
PubMed1985

Hematozoa of raptors from southern New Jersey and adjacent areas.

Blood smears from 259 birds of 12 species, representing four families of raptors, from New Jersey, Pennsylvania, Delaware, and Virginia were examined for blood parasites. Infected birds constituted 59.1% of the total. Birds were infected with one or more of the following genera of protozoa: Leucocytozoon (43.2%); Haemoproteus (21.6%); Plasmodium (1.2%); and Trypanosoma (1.2%). Blood culture of 142 raptors of 11 species for Trypanosoma revealed a prevalence of 41.5%. Plasmodium circumflexum is reported for the first time in Accipiter striatus, and Trypanosoma sp. in Buteo jamaicensis.

Animals↗
PubMed1996

Polycystic kidney disease in a raccoon (Procyon lotor).

During March 1988, a case of bilateral polycystic kidney disease (PKD) occurred in an aged raccoon (Procyon lotor) at a zoo in Wilmington, Delaware (USA). Prior to its death, the raccoon had no clinical signs. On necropsy there was bilateral enlargement of kidneys which, on cut sections, had many variable sized fluid-filled cystic cavities. Endometrial hyperplasia with presence of multiple variable-sized cysts were also seen in the uterus of this raccoon. Microscopical examinations were characteristic of an end-stage renal failure due to PKD. Neither PKD nor cystic endometerial hyperplasia appears to have been previously described in this species.

Animals↗
PubMed1999

ACE inhibitor/CHF interim report. West Virginia Medical Institute.

The analysis upon which this publication is based was performed under Contract 500-96-P603, entitled, "Utilization and Quality Control Peer Review Organization for the State of Delaware," sponsored by the Health Care Financing Administration (HCFA), Department of Health and Human Services. The content of this publication does not necessarily reflect the views of or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the Health Care Quality Improvement Program initiated by HCFA, which has encouraged the identification of quality improvement projects derived from analysis of patterns of care, and therefore, required no special funding on the part of this Contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcome.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Recruitment strategies used by an allied health education program to increase student enrollment.

OBJECTIVE: To increase student enrollment in and public awareness of a Clinical Laboratory Science (CLS) program so that the program would not be eliminated by the University. SETTING: The Medical Technology (MT) program at the University of Delaware (UD). PRACTICE DESCRIPTION: The MT program is a 2 + 2 university-based program established in 1948. The program is accredited for 26 students. PRACTICE INNOVATIONS: Various recruitment activities were used to increase enrollment including presentation at high schools, and panel discussions and open houses held on campus. Extensive publicity on and off campus was used to inform the community about CLS. MAIN OUTCOME MEASURE: Student enrollment in the program and the results of a survey administered to students enrolled in a CLS introductory course. RESULTS: There were 22 students in the 1993-1994 graduating class compared to 10 in the 1992-1993 class. The enrollment also increased for the junior, sophomore, and freshman classes. Because of increased student enrollment and public awareness, the University decided not to eliminate the MT program. CONCLUSION: No single recruitment activity contributed to the increased numbers; rather, it appears that all of the activities contributed to the rise in enrollment of MT majors at UD.

Delaware↗
PubMed1999

Trematode accumulation by the estuarine gastropod Ilyanassa obsoleta.

The accumulation of larval trematodes by Ilyanassa obsoleta (Gastropoda) at 2 estuarine sites in Delaware was studied. Initial infection status of snails was assayed by looking for shed cercariae. Native snails (most already infected) were deployed at sites A and B, and sentinel snails (putatively uninfected) were deployed at site B. All were individually marked and, if found, reassessed for infection after being free 1-3 summers. Himasthla quissetensis, Lepocreadium setiferoides, Zoogonus rubellus, Austrobilharzia variglandis, and Gynaecotyla adunca infections were observed in recovered snails. At site A, in 1993, 62 natives were recovered. Among the 26 initially testing uninfected, 15 had infections at recovery. Of 36 that released cercariae, 26 had the infection initially indicated. Of sentinels released at site B in 1996, 3 of 16 had infections when recollected. One probably was infected before transplant; at least 2 were infected at site B during 1996-1997. Among site B natives, 26 were later examined by dissection in 1996; 22 had the infection status initially revealed. Some site B natives (n = 35) escaped recapture in 1996 but were found in 1997, or 1998, or both, and were reexamined, most by cercarial release. The same cercariae were produced by 30. Among natives (both sites, n = 123), 27.6% exhibited some difference in infection status compared to the initial assay. This probably overestimates changes. Some differences were real but most can be discounted as cases where initial infection status was misrepresented.

Animals↗
PubMed2000

Barriers to the delivery of adequate hemodialysis in ESRD Network 4.

Dialysis dose has been established as a determinant of morbidity and mortality in chronic hemodialysis patients. To identify remediable barriers to the delivery of adequate hemodialysis, we examined factors that affected adherence to prescribed dialysis dose. End-Stage Renal Disease (ESRD) Network 4 facilities that fell into the lowest quintile in measures of dialysis adequacy were studied. At the time of this study, Network 4 was composed of 178 dialysis facilities in Delaware and Pennsylvania. Those 29 facilities had an average delivered urea reduction ratio (URR) of <0.67 and/or 71% of patients with a URR of 0.65. (The mean URR value of Network 4 was 0. 699 with a compliance ratio of 80%.) Dialysis treatment sheets were reviewed for all patients in the 29 facilities for all treatments during a calendar week. Predialysis and postdialysis blood urea nitrogen (BUN) values from 1 treatment during this week were used to calculate URR and Kt/V. A total of 1,339 patients with a mean age of 61.9 +/- 15.1 years and a mean duration of ESRD of 3.4 +/- 3.3 years were dialyzed in the 29 units. Mean prescribed duration of dialysis (T) was 219 +/- 26 min. with a mean blood flow rate (BFR) of 393 +/- 62 mL/min. Concordance between the prescribed and delivered T (-5 min), BFR (-50 mL/min), and hemodialyzer were assessed, by patient, for each treatment (Tx). Characteristics of a delivered Kt/V < 1.2 were duration <4 hours, BFR < 350 mL/min, patient weight > 100 kg, and delivered BFR 50 mL/min less than prescribed BFR. Multivariate analysis of the relationship between delivered dose of dialysis and patients and treatment characteristics identified black race, male gender, and younger age as demographic factors associated with low delivered dose. Potential remediable barriers identified by this analysis included reduced treatment time (>10%) and use of catheters for angioaccess. These data suggest components of the dialysis process that might be targeted in future quality improvement projects to improve the adequacy of dialysis delivery.

Adult↗