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PubMed1997

A state mental health system with no state hospital: the Vermont plan ten years later.

The feasibility and desirability of closing Vermont's only state hospital have been debated for ten years. The author examines the current status of the state department of mental health's plan to close the state hospital and concludes that although closure would be feasible, it would not be desirable. It would reduce the tertiary capacity of the mental health care system and would limit care for severely and persistently mentally ill persons who resist treatment and who have few social resources.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Outpatient therapeutic recommendations by diabetes educators in a rural vermont hospital.

Because of the rapid increase in the incidence of Type 2 diabetes that is occurring in southwestern Vermont (which correlates with the national increase), a "therapeutic guidelines" worksheet was developed to assist primary care providers with the management of Type 2 diabetes patients. Hospital-based diabetes nurse educators access cholesterol and A1C information from the hospital laboratory, assess the patient, and then make recommendations to the primary care provider. The worksheet is designed to be easily used by both the educator and the primary care provider. Feedback has been positive, as the worksheet serves to enhance providers' ability to treat patients and to achieve recommended treatment goals.

Administration, Oral↗
PubMed1998

Cooperative Cardiovascular Project (CCP) quality improvement in Maine, New Hampshire, and Vermont.

The Cooperative Cardiovascular Project (CCP) is a nationwide quality improvement project (quality indicator measurement, feedback, remeasurement) in Medicare acute myocardial infarction (AMI) patients sponsored by the Health Care Financing Administration (HCFA). In Maine, New Hampshire, and Vermont, 3,472 baseline records were abstracted from 76 hospitals from January 1994 to February 1995. After feedback, 2,270 remeasurements were collected from October 1996 to May 1997. At remeasurement, performance improved significantly for "ideal" candidates (defined by the CCP) on five quality indicators--aspirin during hospitalization 88% to 93% (p < .001), thrombolytic timing 60% to 69% (p < .01), discharge aspirin 83% to 90% (p < .001), discharge beta-blockers 69% to 82% (p < .01), and calcium channel blocker avoidance 83% to 93% (p < .05). Reperfusion, angiotensin converting enzyme inhibitors, and smoking cessation advice did not improve significantly. This study demonstrates that evidence-based indicators, nationally designed data collection, and locally based interventions can significantly improve AMI care.

Chi-Square Distribution↗
PubMed2004

Moving in between mammography: screening decisions of American Indian women in Vermont.

Breast cancer is a leading cause of cancer death among American Indian women, with mammography screening rates below the national average for this population. A grounded theory study, conducted with Vermont American Indian women, explicated factors that influence mammography decision making. The authors examined mammography decision making across the breast cancer screening continuum: women with a history of consistent annual mammograms, women who were under users or nonusers of mammography, and women who were breast cancer survivors. The generated theory, Moving in Between Mammography, describes the decision-making process and factors that influenced women's participation in routine mammography screening. Specific influencing factors addressed include Connecting to Nativeness, Taking Care of Self, Financing Health Care, and (Mis)Trusting the Health Care System. Implications and directions for future research are addressed.

Breast Neoplasms↗
PubMed2006

The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry.

Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.

Anesthesia, Spinal↗
PubMed2003

Challenging pharmaceutical industry political power in Maine and Vermont.

A comparison of the Vermont and Maine cases of attempting to control pharmaceutical prices in the year 2000 shows that the Maine legislators were more successful in challenging pharmaceutical industry political power. This comparison shows that challenging the industry was aided by (1) mobilizing public support through grassroots organizations, (2) including independent pharmacists in negotiations over the legislation, and (3) developing state purchasing power leverage.

Aged↗
PubMed2004

Civil unions in Vermont: political attitudes, religious fundamentalism, and sexual prejudice.

In 2000, Vermont passed civil union legislation that granted same-sex couples the same legal rights as traditionally married opposite sex couples. This study examined the influence that sexual prejudice, religious fundamentalism, social dominance orientation, and support for civil unions had on voters' choice for governor in the subsequent election. Results showed that support for civil unions was a primary motivator for many voters in the election, and that sexual prejudice, religious fundamentalism, and social dominance orientation were unique predictors of voters' choices. These results show that prejudice can be a key factor in determining whom voters elect to represent them in government.

Adult↗
PubMed2006

Spanish-speaking dairy workers in New York, Pennsylvania, and Vermont: results from a survey of farm owners.

A New York Center for Agricultural Medicine and Health (NYCAMH) study surveyed 294 dairy farms in New York, Pennsylvania, and Vermont. The study utilized a quarterly telephone survey to assess the proportion of Spanish-speaking workers on these farms, and also to contrast the hazard level of work tasks and prevalence of lost work time between Spanish- and English-speaking workers. The total workforce followed in the study was comprised of 14.4 percent Spanish-speaking workers, with larger farms having a higher proportion than smaller farms (19.9% versus 4.6%, respectively). Of the 294 farms, 22.5 percent had at least one Spanish-speaking worker, which differed, greatly between larger and smaller farms (51.5% versus 7.3%). Spanish workers were significantly younger, worked significantly longer hours and had significantly fewer years of employment than their English-speaking counterparts. Work hour differences were more pronounced on the larger farms. Lost work time, due to on-farm injuries, did not differ between the Hispanic workers and the non-Hispanic workers. After correcting for both age and length of farm employment, Spanish-speaking workers were far less likely to perform managerial functions than their English-speaking counterparts (OR = . 22 p < .01).

Adult↗
PubMed2001

Collaborative quality improvement for neonatal intensive care. NIC/Q Project Investigators of the Vermont Oxford Network.

OBJECTIVE: To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. DESIGN: Interventional study. Patient demographic and clinical information for infants with birth weight 501 to 1500 g was collected using the Vermont Oxford Network Database for January 1, 1994 to December 31, 1997. SETTING: Ten self-selected neonatal intensive care units (NICUs) received the intervention. They formed 2 subgroups (6 NICUs working on infection, 4 NICUs working on chronic lung disease). Sixty-six other NICUs served as a contemporaneous comparison group. PATIENTS: Infants with birth weight 501 to 1500 g born at or admitted within 28 days of birth between 1994 and 1997 to the 6 study NICUs in the infection group (n = 3063) and the 66 comparison NICUs (n = 21 509); infants with birth weight 501 to 1000 g at the 4 study NICUs in the chronic lung disease group (n = 738). INTERVENTIONS: NICUs formed multidisciplinary teams that worked together under the direction of a trained facilitator over a 3-year period beginning in January 1995. They received instruction in quality improvement, reviewed performance data, identified common improvement goals, and implemented "potentially better practices" developed through analysis of the processes of care, literature review, and site visits. MAIN OUTCOME MEASURES: The rates of infection after the third day of life with coagulase-negative staphylococcal or other bacterial pathogens for infants with birth weight 501 to 1500 g, and the rates of oxygen supplementation or death at 36 weeks' adjusted gestational age for infants with birth weight 501 to 1000 g. RESULTS: Between 1994 and 1996, the rate of infection with coagulase-negative staphylococcus decreased from 22.0% to 16.6% at the 6 project NICUs in the infection group; the rate of supplemental oxygen at 36 weeks' adjusted gestational age decreased from 43.5% to 31.5% at the 4 NICUs in the chronic lung disease group. There was heterogeneity in the effects among the NICUs in both project groups. The changes observed at the project NICUs for these outcomes were significantly larger than those observed at the 66 comparison NICUs over the 4-year period from 1994 to 1997. CONCLUSION: We conclude that multidisciplinary collaborative quality improvement has the potential to improve the outcomes of neonatal intensive care.

Chronic Disease↗
PubMed1997

Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network.

BACKGROUND: The outcomes for very low birth weight infants vary among neonatal intensive care units (NICUs), but the reasons for this variation are not well understood. We used the database of a large neonatology research network to determine whether either admission characteristics of the infants or specific characteristics of the units such as annual patient volume and the presence of a pediatric residency program could account for observed differences in neonatal mortality rates among units. METHODS: We studied 7672 infants with birth weights from 501 to 1500 g treated during 1991 and 1992 at 62 NICUs participating in the Vermont Oxford Network Database. RESULTS: Overall, 14.7% of the study infants died within 28 days of birth (interquartile range 9.9% to 18.1%). The ratio of the number of observed deaths at an NICU to the number of deaths predicted based on the characteristics of infants treated at the NICU (standardized neonatal mortality ratio, [SNMR]) varied significantly among units (range 0 to 1.69, z = 4.24). There was no association between annual patient volume and either mortality rate (r = .17) or SNMR (r = .22). Observed mortality rates (17% vs 13%) and SNMR (1.04 vs .87) were both higher at the 24 hospitals with pediatric residency training programs than at the 38 hospitals without such programs. Hospitals with residency programs had higher average annual patient volumes (104 vs 66). In an analysis simultaneously adjusting for patient characteristics, volume, and presence of a residency program, neither volume (odds ratio [OR] per 10 additional cases treated 1.01, 95% confidence interval [CI], .98 to 1.04) nor presence of a pediatric residency program (OR 1.18, 95% CI, .94 to 1.47) was significantly associated with neonatal mortality risk. CONCLUSION: There are differences in neonatal mortality rates among NICUs that cannot be explained by differences in the measured admission characteristics of the infants, suggesting that the effectiveness of medical care varies among units. Neither the annual volume of very low birth weight infants treated in a unit nor the presence of a pediatric residency training program was independently associated with neonatal mortality rates for very low birth weight infants.

Health Care Surveys↗
PubMed2006

Development of a culturally specific instrument for mammography screening: an example with American Indian women in Vermont.

This article presents the triangulation process for translating qualitative data about mammography screening from a grounded theory study with American Indian women in Vermont, into questionnaire items based on an existing model of behavior change, the Transtheoretical Model (TTM) Stages-of-Change. Qualitative data were used to derive a theory, Moving in Between Mammography, which suggested that traditionality influenced American Indian women's screening decisions. To examine the relationship between mammography and traditionality, new items were developed for each of three key TTM constructs: Pros, Cons, and Processes-of-Change. The process for developing the new TTM-based items, as well as traditionality items specific for American Indian women living off-reservation, are presented. This article provides one example of how an instrument can be developed within a culturally competent nursing framework.

Adult↗
PubMed1980

Respiratory symptoms and lung function in a sample of Vermont dairymen and industrial workers.

This study reviews the respiratory status of a sample of Vermont male dairy farmers, and a comparison group from industry, matched for age, sex and smoking. Survey instruments included a standardized questionnaire and simple pulmonary function tests. In general, past and present smokers had more respiratory symptoms than never-smokers; and farmers, in all smoking categories, reported symptoms with greater frequency than did their counterparts from industry. Forced vital capacity (FVC) tended to be lower among men with a history of smoking but, within each smoking category, dairymen and factory workers had very similar FVCs. Farmers who had never smoked or who were current cigarette users had lower FEV1/FVC (forced expiratory volume at one second/forced vital capacity) ratios than their controls from industry. Sixteen diarymen demonstrated precipitins to either Micropolyspora faeni (13) or Thermoactinomyces vulgaris, (3), but only one reported a constellation of symptoms compatible with farmer's lung disease. The estimated prevalence of antibodies to thermophilic actinomyces in this farm population was approximately 10 per cent. Although sample sizes were limited, dairymen from small farms tended to be older, have more respiratory symptoms, less satisfactory pulmonary function, and more serologic evidence of exposure to farmer's lung antigens than their counterparts from large farms.

Adult↗
PubMed1981

Asbestos in Vermont schools: findings of a statewide on-site investigation.

Materials containing asbestos were found in 75 per cent of 336 Vermont Schools constructed or renovated between 1946 and 1974, with two-fifths of the materials in student exposure areas. Findings from visits to all schools contrasted with an earlier investigation relying on self-reporting. Of 105 schools with student exposure disclosed by the current survey, only eight had been identified in the earlier effort. Ceiling tiles, previously not believed to contain substantial asbestos material, constituted a source of student exposure in 36 schools.

Asbestos↗
PubMed1983

Comparison of an active and passive surveillance system of primary care providers for hepatitis, measles, rubella, and salmonellosis in Vermont.

Between June 1, 1980 and May 31, 1981, the Vermont Health Department telephoned a randomly chosen half of the state's primary care offices for surveillance reports of hepatitis, measles, rubella, and salmonellosis. No reports were actively solicited from the other half of the primary-care practices in the state. Active-surveillance units made more reports and more complete reports of diseases and had twice the number of reports per patient seen by the practice than did passive-surveillance units. (Am J Public Health 1983; 73:795-797.)

Hepatitis↗
PubMedDate not supplied

Effects of agricultural runoff on vegetation composition of a priority conservation wetland, Vermont, USA.

This study examined the effects of agricultural runoff on the vegetation structure of Franklin Bog, a priority conservation area located in a rapidly developing region of northwestern Vermont. Forested and agricultural runoff from the mixed land use watershed created differential vegetation patterns in the wetland, including weedy species introductions. Concentrations of nitrogen and phosphorus were measured in the stream runoff from four forested subwatersheds and two agricultural subwatersheds. Nutrient concentrations were significantly higher for agricultural vs. forested runoff for all measured parameters. Nitrate and total phosphorus concentrations in agricultural runoff ranged from 0.62 to 1.35 mg L(-1) and 0.07 to 0.37 mg L(-1), respectively. Forested runoff values were less than 0.37 mg L(-1) nitrate and 0.09 mg L(-1) total phosphorus. Significantly higher proportions of weedy species occurred at impacted vs. reference sites (46 +/- 5% vs. 23 +/- 4%). Furthermore, significantly higher total percent vegetated cover occurred at impacted vs. reference sites (116 +/- 11% vs. 77 +/- 9%) suggesting nutrient induced plant growth. Of the nine frequently occurring species categorized as bog species, only one was found within impacted sites while all nine were found at the reference sites. This suggests that the wetland's distinctive native flora is being replaced by widespread, vigorous species enhanced by agricultural nonpoint pollution in the watershed of Franklin Bog. Protection of wetlands requires attention to conservation measures throughout the entire watershed.

Agriculture↗
PubMed1979

The Vermont epidemic of Legionnaires' disease.

Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.

Adolescent↗
PubMed1999

Opinions of MDs, RNs, allied health practitioners toward osteopathic medicine and alternative therapies: results from a Vermont survey.

The authors surveyed 191 allopathic physicians (MDs), registered nurses (RNs), and allied health professionals (AHPs) regarding their opinions toward osteopathic medicine and alternative therapies. A self-administered questionnaire was distributed to these healthcare professionals practicing in a rural region of west-central Vermont. Participants responded to six questions concerning osteopathic medicine and 18 types of alternative therapies. These questions addressed safety issues, efficacy, personal experience, patient referrals, interest in learning more about alternative medicine, and whether alternative medicine should be provided at the regional hospital. The number of positive responses was totaled as a positive opinion score (POS) for each respondent. Survey results indicated that MDs' general acceptance of osteopathic medicine was less than that of relaxation techniques, massage therapy, self-help groups, and acupuncture. Allopathic physicians' opinions toward osteopaths mirrored that shown toward chiropractors. Nevertheless, MDs responded more positively to osteopathy than did RNs and AHPs. Overall, RNs had a higher opinion of alternative therapies (mean POS 50.4) than did AHPs (mean POS 41.7) or MDs (mean POS 36.0; F = 4.98; P-value = 0.009). Among MDs, primary care providers averaged a POS of 41.1, while specialists had a mean POS of 24.0 (F = 6.85; P-value = 0.012). Overall, female respondents had a mean POS of 45.7 and men had a mean POS of 37.0 (F = 3.91; P-value = 0.051). The POS did not correlate with age (Pearson's r test; r = -0.105).

Adult↗
PubMed1986

Prevalence of avian hematozoa in central Vermont.

Peripheral blood smears from 1,547 birds, of 50 species, from 15 families trapped in Northfield, Vermont were examined for hematozoa. Numerous new host-parasite relationships were identified. The prevalence of all species of parasites over the 3 yr of the study was 42.5%. Prevalence of the genera of parasites were: Leucocytozoon--36.5%; Trypanosoma--7.3%; Haemoproteus--6.3%; microfilariae--1.0%; Plasmodium--1.0%. Peak prevalence (78.9%) occurred in the first half of July. Peak intensity was seen in the last half of June. Evidence from immature birds suggested that active transmission of all genera of hematozoans took place in the study area. Leucocytozoon gametocytes, unlike Haemoproteus gametocytes, were detected in smears from birds during all seasons of the year, and showed no period of complete remission. Trypanosoma and microfilariae also were seen throughout the year.

Aging↗