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PubMed1981

Occurrence of erythema chronicum migrans and Lyme disease among children in two noncontiguous Connecticut counties.

In May-November 1977 erythema chronicum migrans of Lyme arthritis occurred in at least 12 children in New London County, Connecticut, east of the original 3-town epidemic focus. The attack rate (0.15 cases per 1,000 persons under 18) was considerably lower than within the focus itself but similar to the rate in towns west of the focus. No cases were identified in Litchfield County in northwest Connecticut. Observed rates of Lyme disease varied markedly within Connecticut in 1977.

Adolescent↗
PubMed2002

Contrasts in cancer prevalence in Connecticut, Iowa, and Utah.

BACKGROUND: Cancer prevalence--the proportion of a population with cancer, including those recently diagnosed, those in treatment, and survivors--is an important indicator of future health care requirements. Only limited information on cancer prevalence is available for the United States. In particular, comparative interstate studies are not available. In this study, we estimate and analyze the prevalence of seven major cancers in Connecticut, lowa, and Utah using the tried and tested PREVAL method applied to National Cancer Institute registry data. METHODS: We analyzed data on 242,851 carcinomas of the stomach, colorectum, pancreas, breast, uterus (corpus), ovary, and non-Hodgkin lymphoma (NHL), diagnosed in white Americans from 1973 through 1992. Observed prevalence was estimated by applying the PREVAL method to incidence and life status data from the cancer registries. Complete prevalence was estimated by applying correction factors obtained by modeling incidence and survival rates. RESULTS: The ratio of the highest to the lowest prevalence (as proportions) ranged from 1.69 for uterine carcinoma to 2.73 for stomach carcinoma, showing that marked differences in cancer prevalence exist within the United States. Utah had the lowest prevalence for each carcinoma. Connecticut and lowa had similar prevalence levels for carcinomas of the colorectum, pancreas, and ovary and for NHL. Breast carcinoma was the most prevalent, with 826 cases per 100,000 of population in Utah, 1518 per 100,000 in lowa, and 1619 per 100,000 in Connecticut. Cancer survival did not differ greatly among the three registry populations. The major determinants of prevalence differences were incidence and the population age distribution. CONCLUSIONS: PREVAL provides reliable estimates of the numbers of living people in a population who have had a cancer diagnosis. Prevalence depends on incidence and survival and on the age structure of population. All these factors have changed markedly in recent years and will continue to do so in the future. Cancer prevalence should be monitored over time to evaluate changes by area, sex, age, and cancer site. The prevalence figures presented are directly comparable with those from European cancer registries.

Adult↗
PubMed1980

Malignant melanoma in Connecticut and Denmark.

The rising incidence of malignant melanoma of the skin was reviewed using data from the Connecticut Tumor Registry (1935-1974) (Eisenberg et al., 1967) and the Danish Cancer Registry (1942-1972) (Clemmesen, 1965, 1974, 1977). A total of 7,530 cases were analyzed according to age, sex and anatomic site. The total age-adjusted incidence rates were similar for these two countries, despite geographic and demographic differences. HOwever, the most rapid changes in melanoma incidence were observed in females from Denmark and males from Connecticut. In addition, the largest increases occurred for lower-extremity lesions in Danish middle-aged women and trunk-neck melanomas in Connecticut middle-aged men. Melanoma of the face was resistant to changing incidence and occurred in an older age group than melanoma of other skin sites. In general, birth cohort analysis confirmed that changing incidence began for persons born around 1900, but the rising incidence for lower-extremity melanomas in women and trunk-neck melanomas in males began earlier. In comparing incidence for anatomic sites by correcting for surface area and melanocyte density, higher than expected rates were seen for melanoma of the face in both sexes and trunk-neck melanoma in the males. The data presented support the concept that a cumulative exposure to solar radiation may be important in the etiology of melanoma of the face, but short-, intense sun exposure is probably related to melanoma in other sun-exposed areas, and that melanoma in areas other than the face is responsible for the rising incidence of this disease.

Adult↗
PubMed1994

Malignant melanoma incidence in Connecticut (United States): time trends and age-period-cohort modeling by anatomic site.

This study examined time trends and age-period-cohort patterns in the incidence of cutaneous malignant melanoma (CMM) by gender and anatomic site in Connecticut (United States) between 1950 and 1989, using data from the population-based Connecticut Tumor Registry. A total of 8,249 invasive CMM incident cases were included. Cases were grouped into melanomas of the head and neck, upper limb, lower limb, and trunk. Between 1950 and 1989, rates increased substantially for all sites. The largest relative increases occurred in melanoma of the upper limb for both males and females; the largest absolute increase occurred for melanoma of the trunk in males; and the smallest increase occurred in head and neck melanoma in females. Recent trends for time periods 1970-89 among birth cohorts 1930-69 indicated that the rate of increase of CMM is slowing substantially among males, but not among females. Nevertheless, continued overall increases in CMM incidence are likely in Connecticut in the 1990s in both genders, with a decrease in the male-female ratio. The age-period-cohort patterns were significantly different between the genders and among anatomic sites, suggesting different trends in carcinogenic exposures (mainly ultraviolet radiation from the sun) or etiologic distinctions between males and females and among the sites.

Adult↗
PubMed1985

Changes in the prevalence distribution of hypertension: Connecticut adults 1978-79 to 1982.

In the Spring and Summer of 1982 the Second Connecticut Blood Pressure Survey (CBPS-II) was completed. This survey is independent of, but essentially identical in design and implementation to the First Connecticut Blood Pressure Survey reported on by Freeman et al. [1]. This paper compares the results of the two surveys using the same analytic techniques as reported previously [2]. In addition, a model for analyzing the components of hypertension control is utilized in the analysis. Finally, the implications of the survey comparison are discussed in the context of the Connecticut High Blood Pressure Program (CHBP) [3].

Adolescent↗
PubMed1990

Oral cancer: a survey of 566 cases from the University of Connecticut Oral Pathology Biopsy Service, 1975-1986.

A survey of the University of Connecticut Oral Pathology Biopsy Service was undertaken to analyze cases of oral cancer accessioned during the 12-year period, 1975 through 1986 inclusive. Of 33,429 total specimens accessioned, there were 546 malignant oral neoplasms diagnosed and reported. Sixty-five (11.5%) originated from out of state. Invasive intraoral squamous cell carcinoma was the predominant tumor (69.7% of total), whereas lip cancer constituted only 2.8% of all malignancies. Minor salivary gland adenocarcinomas accounted for 11% of total malignancies whereas verrucous carcinoma, carcinoma in situ, and miscellaneous other forms of oral cancer accounted for the remainder (4.6%, 5.3%, and 6.6%, respectively). Cases of invasive squamous cell carcinoma were further analyzed by year, sex distribution, location subsite, age at diagnosis, and histologic grade. With the exception of histologic grading, we found that the characterization of cases of squamous cell carcinoma within the biopsy service tended to parallel results from a separate but related statewide analysis of both oral cancer and intraoral squamous cell carcinoma from Connecticut over a much longer time span. We concluded that the picture of oral cancer as characterized by cases within the University of Connecticut Oral Pathology Biopsy Service is generally reflective of the disease on a statewide level.

Adult↗
PubMed2004

Prostate cancer mortality in Connecticut, Iowa and New Mexico African American men.

We sought to assess trends in prostate cancer incidence, treatment and mortality in African American men by means of analysis of prostate cancer data from three states, Connecticut, Iowa and New Mexico, all participants in the Surveillance, Epidemiology, and End Results (SEER) Program. Compared with levels before prostate specific antigen (PSA) testing, prostate cancer incidence increased in all three states after widespread testing. For men diagnosed with localized or regional prostate cancer, the respective increases in radical prostatectomy in Connecticut, Iowa, and New Mexico were 3.2, 2.3, and 4.9 times pre-test levels. Age-standardized mortality in Connecticut and Iowa increased slightly; in New Mexico the 104.7 deaths per 100,000 in 1979-1986, 62.1 in 1987-1990, dropped to 47.6 in 1991-1998, an amount of decline that was statistically significant. Introduction of PSA testing influenced early detection and treatment of prostate cancer in all three states. Although decline in prostate cancer mortality in New Mexico over time may be linked with use of the PSA test and definitive therapy, the relationship among these factors, and thus the proper treatment for the early stages of this condition, is unclear on the basis of these data.

Black or African American↗
PubMed2006

Safety of carotid endarterectomy in a high-risk population: lessons from the VA and Connecticut.

BACKGROUND: The safety and efficacy of carotid endarterectomy (CEA) have been demonstrated in randomized trials, but these studies excluded patients thought to be at higher risk for poor outcomes. We sought to determine whether patients undergoing CEA in Veteran Affairs Hospitals (VA) were at higher risk and had different outcomes, compared with patients in nonfederal hospitals. STUDY DESIGN: Records of all CEA performed in the VA Connecticut Healthcare System between October 1997 and September 2002 were examined and compared with CEA performed in all nonfederal Connecticut hospitals (CT). RESULTS: There were 7,089 CEAs performed (VA, 140; CT, 6,949). VA patients had increased comorbidity scores and symptomatic presentation (39% versus 14%; p < 0.0001). Perioperative mortality rates were 1.4% (VA) and 0.3% (CT) (p = 0.06). Perioperative stroke (VA, 1.4% versus CT, 0.9%; p = 0.15) and cardiac complication (VA, 2.9% versus CT, 2.1%; p = 0.54) rates were similar. Multivariate analysis demonstrated that perioperative mortality correlated with symptomatic presentation (odds ratio 11.7, p < 0.0001), but not performance, in a VA hospital (p = 0.23); patients treated at the VA were also not at higher risk for stroke (p = 0.94) or cardiac complications (p = 0.90). CONCLUSIONS: Despite increased severity of illness and symptomatic presentation, VA patients had similar perioperative outcomes compared with patients undergoing CEA in nonfederal hospitals in the state of Connecticut. These results suggest not only that patients undergoing vascular surgery at the VA may form a higher-risk population compared with patients receiving care in non-VA hospitals, but that these high-risk patients can undergo CEA safely.

Comorbidity↗
PubMed2005

Connecticut statewide sTEP wave evaluation.

INTRODUCTION: Selective Traffic Enforcement Programs (sTEPs) are a proven method to change motorists' behavior. Since 1997, the Connecticut DOT's Division of Highway Safety has organized a statewide seat belt enforcement program, with sTEP waves every three or four months. To date, 28 waves have been implemented. METHOD: Pre-wave and post-wave seat belt observation surveys are conducted by both state and municipal police across the state. Survey results, as well as a summary of all enforcement activity during the wave, are submitted for evaluation. RESULTS: Connecticut seat belt use has continued to rise from one wave to the next in a predictable "saw blade" pattern. CONCLUSIONS: The data clearly demonstrate that agencies that have participated in a greater number of waves have experienced the greatest increase in belt use. Belt use has not yet plateaued and additional sTEP enforcement seems indicated. However, evidence from other states suggests that a plateau may occur somewhere in the mid 80% range. IMPACT ON INDUSTRY: Should this occur, Connecticut will work toward strengthening the round the clock model, emphasizing the importance of aggressive primary enforcement.

Accidents, Traffic↗
PubMed2006

Connecticut nighttime safety belt use.

PROBLEM: Safety belt use in the United States, as measured over daylight hours, has risen steadily over recent years reaching 80% in 2004. Yet, using the National Highway Traffic Safety Administration's (NHTSA) Fatality Analysis Reporting System (FARS), safety belt use among fatally injured front seat outboard occupants of passenger vehicles was only between 42% and 46% for the years 1999 to 2003. One possible contributing factor is that safety belt use at night, when crash rates are highest, is lower than during the day. METHOD: A full statewide nighttime belt use observation survey was conducted in 2004. This survey was conducted simultaneously with Connecticut's annual full statewide daytime belt use survey. Night belt use observations of drivers and passengers are possible using newly available near military grade night vision goggles and handheld infrared spotlights. Both day and goggle-assisted night observations were conducted at 100 observation sites in Connecticut. Procedures for day and night observations were as nearly identical as possible. RESULTS: The night belt use rate was 6.4 percentage points lower than the day rate (83.0 vs. 76.6). Consistent with belt use among Connecticut fatalities, day versus night differences were greatest in urban areas. There was evidence that day versus night differences were greater before as compared to after a May 2004 belt use enforcement program.

Accidents, Traffic↗
PubMed2001

A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project.

PURPOSE: A statewide quality improvement initiative was conducted in Connecticut to improve process-of-care performance and to decrease length of stay for patients hospitalized with community-acquired pneumonia. SETTING AND METHODS: Data were collected on 1,242 elderly (> or =65 years) pneumonia patients hospitalized at 31 of 32 acute care hospitals between January 16, 1995, and March 15, 1996, and on 1,146 patients hospitalized between January 1, 1997, and June 30, 1997. Interventions included feedback of performance data (Qualidigm, the Connecticut Peer Review Organization), dissemination of an evidence-based pneumonia critical pathway (Connecticut Thoracic Society), and sharing of pathway implementation experiences (hospitals). Process and outcome measures included early antibiotic administration, blood culture collection, oxygenation assessment, length of stay, 30-day mortality, and 30-day readmission rates. Analyses were adjusted for severity of illness and hospital-specific practice patterns. RESULTS: After the statewide initiative, improvements were noted in antibiotic administration within 8 hours of hospital arrival (improvement from 83.4% to 88.8%, relative risk [RR] = 1.21; 95% confidence interval [CI]: 1.10 to 1.32), oxygenation assessment within 24 hours of hospital arrival (93.6% to 95.4%; RR = 1.23, 95% CI: 1.11 to 1.38), and length of stay (7 days to 5 days, P <0.001). There were no significant changes in blood culture collection within 24 hours of hospital arrival, blood culture collection before antibiotic administration, 30-day mortality, or 30-day readmission rates. CONCLUSIONS: Statewide improvements were demonstrated in the care of hospitalized pneumonia patients concurrent with a multifaceted quality improvement intervention. Further research is needed to separate the effects of the quality improvement interventions from secular trends.

Aged↗
PubMed2001

Long-term investigation of atmospheric mercury contamination in Connecticut.

Atmospheric mercury was monitored from January 1997 through the end of December 1999 in eight sampling locations in Connecticut. Four sampling locations were chosen along the shores of Long Island Sound and four were chosen in interior sections of Connecticut. Sampling locations were chosen to represent both rural and urban sectors. Average concentrations of gaseous and particulate mercury were found to be 2.06 ng/m3 and 10.5 pg/m3, respectively. The weekly average wet deposition fluxes of mercury and methylmercury over the three-year sampling period were measured to be 611 and 11 microg/ha/week, respectively. Concentrations of gaseous, particulate and wet flux of mercury were found to be significantly higher in urban areas than the rural sampling locations. There was, however, no significant difference between the mean gaseous and particulate concentrations of mercury in coastal and inland sampling locations. No significant difference was observed either between the wet fluxes of total mercury in coastal and inland sampling locations and there was no spatial gradient for mercury concentration and deposition. The data of this study suggest that vehicular traffic and localized emission sources in urban areas play a significant role in determining the atmospheric concentration of mercury in Connecticut.

Air Pollutants↗
PubMed2003

Effects of geographical location and land use on atmospheric deposition of nitrogen in the State of Connecticut.

A network of eight monitoring stations was established to study the atmospheric nitrogen concentration and deposition in the State of Connecticut. The stations were classified into urban, rural, coastal and inland categories to represent the geographical location and land use characteristics surrounding the monitoring sites. Nitrogen species including nitrate, ammonium, nitric acid vapor and organic nitrogen in the air and precipitation were collected, analyzed and used to infer nitrogen concentrations and dry and wet deposition flux densities for the sampling period from 1997 through 1999, with independently collected meteorological data. Statistical analyses were conducted to evaluate the spatial variations of atmospheric concentration and deposition fluxes of total nitrogen in Connecticut. A slightly higher atmospheric concentration of total nitrogen was observed along the Connecticut coastline of Long Island Sound compared to inland areas, while the differences of nitrogen deposition fluxes were insignificant between coastal and inland sites. The land use characteristics surrounding the monitoring sites had profound effects on the atmospheric nitrogen concentration and dry deposition flux. The ambient nitrogen concentration over the four urban sites was averaged 38.9% higher than that over the rural sites, resulting a 58.0% higher dry deposition flux in these sites compared to their rural counterparts. The local industrial activities and traffic emissions of nitrogen at urban areas had significant effects on the spatial distribution of atmospheric nitrogen concentration and dry deposition flux in the State. Wet and total deposition fluxes appeared to be invariant between the monitoring sites, except for high flux densities measured at Old Greenwich, a monitoring station near to and downwind of the New York and New Jersey industrial complexes.

Agriculture↗
PubMed2001

Children's access to dental care in Connecticut's Medicaid managed care program.

OBJECTIVE: To describe dental care utilization and access problems in Connecticut's Medicaid managed care program, using quantitative and qualitative research methods. METHODS: Using Medicaid managed care enrollment and encounter data from Connecticut, utilization rates for preventive care and treatment services are determined for 87,181 children who were continuously enrolled in Medicaid managed care for 1 year in 1996-97. Sociodemographic and enrollment factors associated with utilization are identified using bivariate and multivariate methods. Dental providers and practices where children received services are described. Qualitative methods are used to characterize problems experienced by families seeking dental care during the study period. RESULTS: Only 30.5% of children continuously enrolled in Medicaid managed care for 1 year received any preventive dental services; 17.8% received any treatment services. Children who received preventive care were eight times more likely to have received treatment services. Utilization was higher among (a) younger children, (b) children who lived in Hartford and in other counties served by public dental clinics, and (c) children enrolled in health plans that did not subcontract for administration of dental services. Just 5% of providers, primarily those in public dental clinics, performed 50% of the services. Families whose children needed care encountered significant administrative and logistical problems when trying to find willing providers and obtain appointments. CONCLUSIONS: Access to dental care is a problem for children in Connecticut's Medicaid managed care program. Several features of managed care have negatively affected access. Public dental clinics served many children across the state and contributed to higher utilization of preventive care and treatment services among children living in Hartford.

Adolescent↗
PubMed2001

Estimation of wet, dry and bulk deposition of atmospheric nitrogen in Connecticut.

Atmospheric nitrogen species including NO3-, NH4+ and total nitrogen in air and precipitation samples were collected with low-volume filter packs and wet deposition collectors from March 1999 through the end of December 2000 in seven sampling locations in Connecticut. Three sampling locations were chosen along the shores of Long Island Sound and four were chosen in interior sections of Connecticut. Sampling sites were chosen to represent both rural and urban sectors. Wet deposition flux of nitrogen species was calculated using wet concentrations, the volume of collected precipitation and the opening surface area of the Aerochemetrics wet deposition collector. The dry deposition flux of nitrogen species was estimated with the application of the dry deposition inferential model (DDIM). Bulk deposition of nitrogen was collected with the aid of a device based on the Swedish IVL Sampler. The dry deposition fluxes of NO3-, NH4+ and total nitrogen were found to be significantly higher in urban areas than the rural sampling locations. There was, however, no significant difference between the wet deposition fluxes of different nitrogen species in rural and urban sampling locations. When inland and coastal sites were compared, the dry deposition fluxes of NH4+ and total nitrogen were significantly higher in inland locations and there was no significant difference between coastal and inland sampling locations for wet deposition fluxes of nitrogen species. No significant difference was observed between the bulk deposition and the sum of the wet and dry deposition fluxes of total nitrogen at rural sampling locations. In urban sampling locations, the bulk deposition flux of total nitrogen was significantly lower than the sum of dry and wet deposition fluxes. There appears to be a similar seasonal trend in wet and dry deposition fluxes of total nitrogen in Connecticut with high and low deposition fluxes occurring in summer and winter periods, respectively.

Air Pollutants↗
PubMed2000

TBI knowledge and pragmatic assessment among Connecticut school speech-language pathologists.

School-based speech-language pathologists from Connecticut responded to a random survey which had a twofold purpose, (1) to replicate a previous conclusion that clinicians' specific experience with traumatic brain injury (TBI) influences their knowledge of this subject, and (2) to explore the topic of pragmatic assessment and whether it is also influenced by specific TBI experience. Results indicate that Connecticut school clinicians favourably regard both their own knowledge of TBI and the contemporary issue of pragmatic assessment. Connecticut clinicians also report a relatively low degree of prior TBI training and clinical experience. Clinicians' degree of TBI training and clinical experience did not appear directly related to their reported competence in TBI knowledge and pragmatic assessment.

Adult↗
PubMed1996

Estimating breast cancer incidence in Hispanic women in Connecticut, 1989-1991.

OBJECTIVES: The objective of this study was to estimate incidence rates for breast cancer, the most commonly occurring cancer in women, in the growing Hispanic population of Connecticut. METHODS: The population-based Connecticut Tumor Registry (CTR) routinely obtains only limited information on Hispanic origin and maiden name. In this study, surnames of CTR breast cancer patients diagnosed in 1989-1991 were matched with a list of Spanish surnames. To assess misclassification, both surnames and maiden names (from death certificates) of female Connecticut residents who had died in 1989-1991 from any cause of death at 20 years of age and older were matched with the Spanish-surname list. RESULTS: Age-specific incidence rates (1989-1991) for 'Hispanic' women (with Spanish surname) were lower than those for 'non-Hispanic' white women (with non-Spanish surname) for age 35-39 years and older. Errors in these estimated rates were probably small because among decedents the number with a Spanish surname differed by only 9% from the number with a Spanish maiden name; false positives were almost balanced by false negatives. CONCLUSION: Matching of surnames in the cancer registry with a Spanish surname list provided reasonably accurate estimates of cancer incidence rates in Hispanic women, although individual women were misclassified as 'Hispanic' or 'non-Hispanic'.

Adult↗
PubMed2006

Indoor radon and lung cancer risk in connecticut and utah.

Radon is a well-established cause of lung cancer in miners. Residents of homes with high levels of radon are potentially also at risk. Although most individual studies of indoor radon have failed to demonstrate significant risks, results have generally been consistent with estimates from studies of miners. We studied 1474 incident lung cancer cases aged 40-79 yr in Connecticut, Utah, and southern Idaho. Population controls (n = 1811) were identified by random telephone screening and from lists of Medicare recipients, and were selected to be similar to cases on age, gender, and smoking 10 yr before diagnosis/interview using randomized recruitment. Complete residential histories and information on known lung cancer risk factors were obtained by in-person and telephone interviews. Radon was measured on multiple levels of past and current homes using 12-mo alpha-track etch detectors. Missing data were imputed using mean radon concentrations for informative subgroups of controls. Average radon exposures were lower than anticipated, with median values of 23 Bq/m3 in Connecticut and 45 Bq/m3 in Utah/southern Idaho. Overall, there was little association between time-weighted average radon exposures 5 to 25 yr prior to diagnosis/interview and lung cancer risk. The excess relative risk (ERR) associated with a 100-Bq/m3 increase in radon level was 0.002 (95% CI -0.21, 0.21) in the overall population, 0.134 (95% CI -0.23, 0.50) in Connecticut, and -0.112 (95% CI -0.34, 0.11) in Utah/Idaho. ERRs were higher for some subgroups less prone to misclassification, but there was no group with a statistically significant linear increase in risk. While results were consistent with the estimates from studies of miners, this study provides no evidence of an increased risk for lung cancer at the exposure levels observed.

Adult↗