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PubMed1983

Incidence of childhood cancer: experience of a decade in a population-based registry.

Incidence rates of cancer among children aged 0-14 for the period 1970-79 have been generated with the use of data from the Greater Delaware Valley (GDV) Pediatric Tumor Registry. This population-based registry covers a 31-county area and has a pediatric base population of 2 million. During the period, approximately 2,300 cases of childhood cancer were diagnosed in the region. Incidence rates for all histologic types combined are similar to rates from other large surveys conducted in the United States and Western Europe. However, certain histology-specific rates in the GDV vary by race. In the GDV nonwhites relative to whites have higher rates of Wilms' tumor, soft tissue sarcomas other than rhabdomyosarcoma, and retinoblastoma. These contrasts are supported by surveys in African populations showing relatively higher rates of these tumors among African black children. GDV whites exceed nonwhites in incidence of acute leukemia, neuroblastoma, and Ewing's sarcoma. African black children also experience low rates of these tumors. The frequency of central nervous system tumors is similar for GDV whites and nonwhites, despite reports of a rarity of these neoplasms in African blacks. Variations in incidence rates reveal population subgroups with particular tumor susceptibilities and may provide clues as to the relative influence of heredity and environment on patterns observed.

Adolescent↗
PubMed1996

Physician performance of preventive care for women.

BACKGROUND: The purpose of this study was to examine whether academic primary care physicians recommended appropriate preventive care to their female patients, whether recommendations differed for different types of physicians, and how often these recommendations led to completion of the preventive service. METHODS: A retrospective chart review was conducted in the family medicine and internal medicine outpatient practices at the Medical Center of Delaware (MCD). A total of 324 women ages 40 and over were selected from the patient panels of nine faculty and 14 residents. Physician recommendation of PAP smears, mammograms, breast exams, and influenza immunizations were measured against the guidelines of the U.S. Preventive Service Task Force. Specifically examined was whether rates of recommendation differed by specialty, gender and faculty/resident status of the physician. Also measured was completion of each preventive service and whether rates of completion differed from rates of physician recommendation. RESULTS: Physicians recommended appropriate PAPs in 72 percent of patients, mammograms in 83 percent of patients, breast exams in 46 percent of patients and influenza immunizations in 30 percent of patients. Family physicians were more likely to recommend PAP smears (odds ratio 5.53, 95 percent confidence interval 2.26-12.98), but not more likely to recommend other services; female physicians were more likely to recommend breast exams (odds ratio 3.48, 95 percent confidence interval 2.05-5.89), but not other services. There were no significant differences between faculty and residents. Preventive services were completed in 48 percent of patients for PAPs, 68 percent for mammograms, 42 percent for breast exams, and 27 percent for flu shots. CONCLUSIONS: In academic primary care practices at MCD, physicians perform well in recommending PAPs and mammograms, but not in recommending breast exams or influenza immunizations. There were few differences in performance among different types of physicians. Because many women did not follow through with their physicians' recommendations for preventive care, physician performance is more accurately measured according to their recommendations rather than completion of services. Efforts to improve preventive care in women should differ depending on whether the problem lies in physician performance or patient behavior.

Adult↗
PubMed1997

Can hospitalizations be avoided by having a regular source of care?

BACKGROUND AND OBJECTIVES: This study sought to determine whether Medicaid patients with a regular source of care (RSOC) are less likely to be hospitalized, either for all conditions or for ambulatory care sensitive conditions (ACSCs), than those without an RSOC. METHODS: This population-based survey study examined Delaware Medicaid patients ages 0-64 over a 1-year period from September 1992 to August 1993 (n = 22,862). Patients who had made more than 50% of their physician office visits to the same provider group were considered to have an RSOC. The probability of hospitalization for all conditions and for ACSCs was compared for persons with and without an RSOC. RESULTS: Eighty-one percent of Medicaid clients had an RSOC, 75% of whom were primary care physicians. Persons with an RSOC were not less likely than those without an RSOC to be hospitalized for any condition (15% versus 14.6%) or for ACSCs (3.4% versus 3.2%). The results were not substantially different for persons who used primary care physicians as their RSOC. CONCLUSIONS: Having an RSOC is not associated with a lower likelihood of hospitalization for the Medicaid population, either for all conditions or for ACSCs. While providing access to care may have other positive benefits, simply providing Medicaid patients with an RSOC is unlikely to result in a short-term reduction in hospital admissions.

Adolescent↗
PubMedDate not supplied

Sequence comparisons of the variable VP2 region of eight infectious bursal disease virus isolates.

The VP2 gene is part of the genomic segment A of infectious bursal disease virus (IBDV). It has been identified as the major host-protective antigen of IBDV and is known to contain conformationally dependent protective epitopes. A 643-base pair segment covering the hypervariable region of this gene from three recent serologic variant IBDV isolates from the southeastern United States, two variants from the Delmarva Peninsula, and three serologic standard viruses were amplified and sequenced using the reverse transcription polymerase chain reaction and cycle sequencing techniques. This was done to determine the molecular similarity among isolates that differ antigenically and pathologically. Sequence analysis suggested that the Arkansas (Ark) and Mississippi (Miss) isolates evolved closely and separately from the Delmarva variants (GLS and DELE), in contrast to the other southeastern variant Georgia (Ga), which is more closely related (98.32%) to Delaware E (DELE). All variants, except for Miss, underwent a shift in amino acid number 222 from proline to threonine. The sequence of Univax BD virus, a commercially available intermediate vaccine, was markedly different, evolving from a separate lineage than the others. Restriction enzyme sites could differentiate most isolates. Except for Miss, variants do not have EcoRII site at the larger hydrophilic domain. All variants lost their HaeIII, StuI, and StyI cutting sites with a change in base number 856. The TaqI site is in DELE, whereas the SpeI site is absent in the standard vaccine viruses. The SWASASGS heptapeptide is conserved in all virulent viruses, including APHIS, but not in the attenuated (Univax BD and Bursa Vac 3) and published (D78 and PBG98) vaccines.

Amino Acid Sequence↗
PubMed1997

Strengthening our child abuse response system.

Medical professionals are often the people who see children first, whether in the safety of a private office, clinic or an emergency room. Your ability to recognize and understand the symptoms of child abuse and neglect, your readiness to report findings to the report line and your availability to provide expert witness testimony are critical to the effectiveness of the child abuse response system in Delaware.

Child↗
PubMed1997

Mycotic infection with mucormycosis.

Mucormycosis comprises infections caused by fungi in the class Zygomycetes (order Mucorales). Clinical infections usually manifest as nasopharyngeal, cutaneous, pulmonary, or disseminated disease. Generally, the infection is found only in immunocompromised hosts. The underlying immunologic defects that are responsible for predisposing different populations of patients to the development of mucormycosis are not well understood. This article retrospectively reviews the experience at the Medical Center of Delaware with this relatively rare fungal infection.

Adult↗
PubMed1997

Himasthla limnodromi n. sp. (Digenea: Echinostomatidae) from the short-billed dowitcher, Limnodromus griseus (Aves: Scolopacidae).

Himasthla limnodromi n. sp. is described from short-billed dowitchers, Limnodromus griseus, from the Araya Peninsula, Venezuela, and Delaware Bay, U.S.A. Himasthla limnodromi was not found in dowitchers on the breeding grounds or on the fall staging grounds in the Bay of Fundy but reappeared in dowitchers on the wintering grounds in the fall. This suggests that H. limnodromi is acquired by the birds on arrival on the wintering grounds and then gradually disappears during the birds' northward migration in the spring. The new species has a reniform collar armed with 31 spines, with 23 in a single uninterrupted row, and 4 corner spines in overlapping pairs at each end. The cirrus sac is up to 10 times longer than the length of the acetabulum and contains a long, smooth cirrus. The vitellaria always commence posterior to the posterior end of the cirrus sac in mature specimens. The testes are found in the posterior eighth of the long, filamentous body. Himasthla limnodromi n. sp. most closely resembles Himasthla alincia, but H. limnodromi is larger in size and has an unspined cirrus and smaller eggs.

Animals↗
PubMed1996

Philip Andrew Traynor, DDS, FACD, (1874-1962).

Philip Andrew Traynor was arguably Delaware's most peerless dentist during his lifetime and even until today. He touched many lives, advanced the prestige of the dental profession, and served his state and country unselfishly as a national legislator. Forceful, no nonsense, take charge, persuasive, athlete, soldier, politico, legislator, canine judge, vocalist, dentist--all words that have been used to identify and describe this remarkable, unwonted, and extraordinary man--truly a dental diamond from the Diamond State. Historically it is important to view Traynor's wide ranging accomplishments in perspective. An Irish Catholic and son of the nation's second smallest state, Dr. Traynor affected the lives of thousands of people the length and breadth of his state and even his nation. Whether at the dental chair or congressional lecturn, Philip A. Traynor, a dual savant, imprinted his hallmark. This paper details the unselfish life of a perspicacious man and exceptional dentist, Philip A. Traynor, DDS.

Delaware↗
PubMed1998

Improving preventive care for women: impact of a performance improvement program in a family practice office.

PURPOSE: In 1993, the Family Medicine Center (FMC) at the Medical Center of Delaware (MCD) implemented a performance improvement (PI) program to increase rates of adult preventive care. This program included adoption of evidence-based preventive care guidelines, education of physicians and nurses regarding these guidelines, development of a flow sheet for tracking preventive care on office charts, and adoption of a policy of nurse review to alert physicians of which preventive services are due. The purpose of this study was to determine whether this PI program had a positive impact on the delivery of preventive care to female patients of the FMC. METHODS: A retrospective chart review was conducted for 280 female patients of the FMC ages 40-75. We determined the percentage of women who had received appropriate screening for breast and cervical cancer as well as appropriate immunizations, according to the guidelines of the US Preventive Services Task Force. These percentages were compared for the three year time periods before and after the PI program was implemented (July, 1990-June, 1993 and July, 1993-June, 1996). RESULTS: Prior to implementation of the PI program, PAP smears were completed in 65.3 percent of women, mammograms in 70.3 percent, breast exams in 44.2 percent, flu shots in 29.6 percent and tetanus shots in 15.5 percent. After the program, these percentages increased for all preventive services, especially PAP smears which increased by 12 percent and tetanus shots which tripled. After the program, the rate of flu shots was still low at 37 percent. CONCLUSIONS: After implementation of a PI program at the FMC, performance of preventive care for female patients improved for both cancer screening and immunizations. This improvement suggests that an office-based strategy can improve performance of preventive care, especially if it incorporates the active involvement of nursing staff. However, there is still room for further improvement, notably with completion of flu shots. These improvements will likely require additional strategies, such as computerized tracking systems and preventive care reminders to patients.

Adult↗
PubMed1998

Health-related quality of life and activity limitation--eight states, 1995.

Since January 1993, CDC's Behavioral Risk Factor Surveillance System (BRFSS) has included four general questions concerning health-related quality of life (HRQOL). The results of these HRQOL measures are useful for population health assessment, epidemiologic research, and policy development, but they are less useful for identifying specific public health interventions because they track general deficiencies such as poor health. Since 1995, state health departments have had the option of including in the BRFSS an expanded set of 14 HRQOL questions; these questions ask about specific types of activity limitation and common physical and emotional symptoms. This report summarizes preliminary findings from the eight states (i.e., Delaware, Indiana, Kansas, Mississippi, Missouri, New Mexico, North Carolina, and Tennessee) in which these other questions were included in the 1995 BRFSS.

Adult↗
PubMed1998

The new diagnosis and classification of diabetes mellitus.

We are in the midst of an epidemic of diabetes, and the prevalence appears to be especially marked within Delaware. To prevent tragic long-term complications of diabetes, and to minimize the enormous costs associated with treating them, an emphasis must be placed on the early diagnosis and aggressive management of diabetes. The changes in the classification, diagnosis and screening for diabetes should help to redirect the focus to one of preventive care.

Delaware↗
PubMed1998

High immunization rates versus missed immunization opportunities in a private pediatric office.

OBJECTIVE: This prospective study examines coverage levels for immunization of two-year-old children in a large private pediatric practice, and delineates the frequency of missed opportunities for vaccination. SETTING: A private single-specialty group pediatric practice in a suburban locale. DESIGN: With the aid of our office billing computer, 218 children between the ages of 21 and 24 months who had ever received medical care in our practice were identified. A manual chart review was performed to identify those children no longer receiving care from us. Of the 189 patients remaining, the immunization records in the patients' charts were compared to the State of Delaware immunization registry to identify those who had not received the full panel of recommended vaccines. Those charts were examined to identify reasons for underimmunization. No patient recall was performed. The charts of underimmunized children were reexamined five months later to determine how many had become fully immunized. RESULTS: On initial review, 86 percent of 21-24 month old children in our practice had received all recommended vaccines. Only 15 percent of the underimmunized children had had a missed opportunity for vaccination in the initial chart review. About half of the underimmunized patients received their missing vaccines over the next five months, yielding an eventual immunization rate of 94 percent. Only two of the 11 children still underimmunized by the end of the study (aged 26 to 29 months) had appeared for an 18 month or a 24 month well child visit; only four of the 11 had had a missed opportunity to receive immunizations during the five month study period. A subsequent chart review showed that 90 percent of our patients were up-to-date at 24 months of age. CONCLUSIONS: Achievement of a 90 percent immunization rate for two year old children is possible in a large private practice. Most underimmunized children in our practice had failed to appear for recommended well visits; a minority experienced missed opportunities for immunization.

Child, Preschool↗
PubMed1993

Taxicabs and child restraint.

For young urban families who may not own a car, taxicabs are a common mode of transportation. We surveyed the frequency of taxicab use involving children younger than age 4 years in a Baltimore, Md, clinic population and studied pediatric occupant safety issues, including taxicab child restraint law exemptions, taxicab occupant morbidity/mortality data, and taxicab child restraint device availability. In our inner-city clinic, 84 (78%) of 108 families reported that they did not own a car and 64 (76%) of those without cars rode with their small children in taxicabs at least monthly (n = 28), weekly (n = 27), or daily (n = 9), all without child restraints. Thirty-five of 50 states (70%) plus Washington, DC, exempt taxicabs from child restraint laws. Only 11 (27%) of 41 states with safety belt laws exempt taxicabs. There were 106 reported taxicab occupant fatalities from 1986 to 1990 in the United States, including 11 children and adolescents. National and state data on motor vehicle occupant morbidity do not separately examine taxicabs. Individual taxicab fleets we contacted would not release injury data. Of 50 urban taxicab fleets in four states (Delaware, Maryland, New Jersey, and Pennsylvania), only three (6%) offered child restraint devices by advance telephone request. There was no difference in availability based on state taxicab exemptions from child restraint laws. We conclude that taxicab use involving young children is common in this inner-city population. Data on taxicab occupant injuries are needed. Child restraint law exemptions for taxicabs should be eliminated. Education about, and enforcement of, child restraint laws for taxicabs is needed. Recent local legislation linking child restraint device availability to taxicab licensure should be encouraged.

Accidents, Traffic↗
PubMed1999

The spread of the obesity epidemic in the United States, 1991-1998.

CONTEXT: The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases. OBJECTIVE: To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults. DESIGN: Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998. SETTING: States that participated in the Behavioral Risk Factor Surveillance System. MAIN OUTCOME MEASURES: Body mass index calculated from self-reported weight and height. RESULTS: The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases). CONCLUSIONS: Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Adult↗
PubMedDate not supplied

State trends in health risk factors and receipt of clinical preventive services among US adults during the 1990s.

CONTEXT: Monitoring trends is essential for evaluating past activities and guiding current preventive health program and policy efforts. Although tracking progress toward national health goals is helpful, use of national estimates is limited because most preventive health care activities, policies, and other efforts occur at the state or community level. There may be important state trends that are obscured by national data. OBJECTIVE: To estimate state-specific trends for 5 health risk factors and 6 clinical preventive services. DESIGN: Telephone surveys were conducted from 1991 through 2000 as part of the Behavioral Risk Factor Surveillance System. SETTING AND PARTICIPANTS: Randomly selected adults aged 18 years or older from 49 US states. Annual state sample sizes ranged from 1188 to 7543. MAIN OUTCOME MEASURES: Statistically significant changes (P<.01) in state prevalences of cigarette smoking, binge alcohol use, physical inactivity, obesity, safety belt use, and mammography; screening for cervical cancer, colorectal cancer, and cholesterol levels; and receipt of influenza and pneumococcal disease vaccination. RESULTS: There were statistically significant increases in safety belt use for 39 of 47 states and receipt of mammography in the past 2 years for women aged 40 years or older for 43 of 47 states. For persons aged 65 years or older, there were increases in receipt of influenza vaccination for 44 of 49 states and ever receiving pneumococcal vaccination for 48 of 49 states. State trends were mixed for binge alcohol use (increasing in 19 of 47 states and declining in 3), physical inactivity (increasing in 3 of 48 states and declining in 11), and cholesterol screening (increasing in 13 of 47 states and decreasing in 5). Obesity increased in all states and smoking increased in 14 of 47 states (declining only in Minnesota). Cervical cancer screening increased in 8 of 48 states and colorectal cancer screening increased in 13 of 49 states. New York experienced improvements for 8 of 11 measures, while 7 of 11 measures improved in Delaware, Kentucky, and Maryland; in contrast, Alaska experienced improvements for no measures and at least 4 of 11 measures worsened in Iowa, North Dakota, and South Dakota. CONCLUSIONS: Most states experienced increases in safety belt use, mammography, and adult vaccinations. Trends for smoking and binge alcohol use are disturbing, and obesity data support previous findings. Trend data are useful for targeting state preventive health efforts.

Adult↗
PubMed2006

Anthropometry and the risk of epithelial ovarian cancer.

BACKGROUND: The association between anthropometric factors and ovarian cancer risk was investigated using data from 762 cases and 1348 controls participating in a population-based case-control study in the Delaware Valley from 1994-1998. Because factors such as oral contraceptive (OC), hormone therapy (HT), and parity may affect weight and hormone levels, the associations were examined in women with and without these characteristics. METHODS: Unconditional logistic regression was used to calculate odds ratios and 95% confidence intervals while controlling for age, race, parity, family history of ovarian cancer, tubal ligation, and OC use. RESULTS: Compared with controls, cases were taller and heavier in recent years and at age 18. Results did not differ by OC or HT use. However, anthropometric associations differed significantly based on parity, as increasing anthropometric measures were associated with increased ovarian cancer risk among nulliparous women only. Adjusted OR for recent body mass index (BMI) quartile 4 compared with quartile 1 for nulliparous women was 2.53 (95% confidence interval [CI]: 1.39, 4.61) compared with 0.96 (95% CI: 0.70, 1.31) for parous women. Additionally, adult weight gain was significant only for nulliparous women. Adjusted OR for weight change (recent to age 18) quartile 4 compared with quartile 1 for nulliparous women was 3.73 (95% CI: 1.88, 7.42) versus 1.09 (95% CI: 0.78, 1.51) for parous women. CONCLUSIONS: BMI and weight in women's adult lifetime may be positively associated with ovarian cancer risk. Observations were most apparent for nulliparous women, possibly reflecting an interaction between local inflammation caused by incessant ovulation and increased estrogen exposure on ovarian epithelium.

Adult↗
PubMed2006

Asian Tobacco Education and Cancer Awareness Research Special Population Network. A model for reducing Asian American cancer health disparities.

Asian Americans are the fastest growing and the second largest foreign-born ethnic group in the United States. Cancer is a leading cause of death among Asian Americans. The Asian Tobacco Education and Cancer Awareness Research (ATECAR) Special Population Network, Center for Asian Health, aimed to reduce or eliminate cancer health disparities in these diverse, underserved populations in Pennsylvania, New Jersey, Delaware, and New York. The ATECAR logic model was adapted from a variety of conceptual frameworks to develop and implement the network's multifaceted cancer health disparities research, training, awareness, and outreach programs. The model was the basis for the developmental phases of the network that included (1) needs assessment, infrastructure, and partnership building; (2) intervention research, training, and mentorship; and (3) evaluation, dissemination, and diffusion. Community involvement occurred at every operational level to ensure program and network sustainability. Between 2000 and 2005, the ATECAR network consisted of 88 partners, representing a cross-section of Asian communities, academia, cancer centers, and health service agencies, ensuring a viable infrastructure for the network's multidimensional cancer health disparities programs. ATECAR's research covered tobacco control, cancer prevention and intervention, and clinical trials. More than 22 research projects were conducted and their results disseminated in peer-reviewed journals. ATECAR also trained 76 junior researchers and special population investigators and 1014 community professionals in disparity issues. ATECAR's multimedia cancer awareness education program reached over 116,000 Asians. The ATECAR network's achievements have had a profound impact on Asian Americans and established a trend toward reducing cancer health disparities, especially among underserved Asian Americans. Cancer 2006. (c) 2006 American Cancer Society.

Asian↗
PubMedDate not supplied

Woodchuck hepatitis virus: experimental infection and natural occurrence.

Sera from 588 woodchucks were assayed for woodchuck hepatitis virus (WHV) markers using hepatitis B virus (HBV) reagents which have cross-reactivity with WHV markers. Twenty per cent of these woodchucks, trapped in Delaware, Maryland and Pennsylvania, had WHsAg; 50% of these had DNA polymerase. There are areas of high and low endemicity within these states. Female woodchucks may have a higher incidence of WHV markers than do males. Woodchuck hepatitis surface antigen (WHsAg) and anti-WHc often occur together but less commonly than HBsAg and anti-HBc do in human HBV infection. Experimental infection of woodchucks with WHV produced a prolonged infection (up to 40 weeks). WHsAg and DNA polymerase appeared to be more reliable indicators of infectivity than anti-WHc, woodchuck hepatitis e antigen (WHeAg) or anti-WHe. WHeAg was not detected throughout this period of infection, while anti-WHe appeared late in two of three experimentally infected animals. Four male and four female woodchucks which developed primary hepatocellular carcinoma in captivity were analyzed for WHV markers throughout their period of confinement. Seven were WHsAg and anti-WHc positive when captured. The animal that was free of WHV markers on capture converted to the WHsAg and anti-WHc positive state prior to the development of primary hepatocellular carcinoma. One primary hepatocellular carcinoma animal produced WHeAg and none anti-WHs or anti-WHe.

Animals↗