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PubMed2006

Survey of lymphocytic choriomeningitis virus diagnosis and testing--Connecticut, 2005.

Lymphocytic choriomeningitis virus (LCMV) is a rodent borne virus that can be transmitted to humans through exposure to rodent urine, feces, saliva, or blood. LCMV infection is often asymptomatic or mild but can cause aseptic meningitis, encephalitis, life-threatening infections in immunosuppressed persons, and severe congenital defects . In May 2005, LCMV was implicated in the deaths of three organ transplant recipients who had received organs from a common donor who had likely been infected from a pet rodent. In August 2005, the Connecticut Department of Public Health conducted surveys of hospital laboratories and infectious disease (ID) physicians in Connecticut to determine recent incidence of confirmed LCMV infection, the level of awareness of LCMV, and the frequency of LCMV testing. This report summarizes the results of those surveys, which indicate that awareness of LCMV is high among ID physicians; however, testing for LCMV is infrequent, and ID physicians might not be aware of the need to consider LCMV among the most susceptible populations even when a history of rodent contact is not initially evident. In part because of these findings, LCMV infection is now a physician- and laboratory-reportable disease in Connecticut. More systematic efforts are needed to determine the frequency of LCMV infection and to monitor for pet rodent infection.

Clinical Laboratory Techniques↗
PubMed1991

Suicidal behaviors among Connecticut youth.

In the United States, youth (15-24 years) suicide rates increased 191% between 1950 and 1986. This paper presents data regarding suicidal ideation and attempts, suicide-related hospitalizations, and completed suicides among Connecticut youth, comparing them with data from other states and the United States. Girls have higher rates of attempts and hospitalization, boys of completed suicide. Firearms are the suicidal method of choice for both sexes. Nonmetropolitan areas had higher rates than metropolitan. Reported suicidal ideation among students ranged from 10% to as high as 66%, while attempts range from 3% to 15%. The authors stress that caution is necessary when comparing rates, pointing to the need for standardized data collection and analysis. Reported rates of suicidal behavior are lower among Connecticut youth compared to their counterparts in other states, but suicide is increasing among young males in Connecticut and remains a major issue for health care providers.

Adolescent↗
PubMed1990

Variations in coding practices among Connecticut urologists for the Medicare population.

As health care costs continue to rise, alternatives to the traditional fee for service system of physician reimbursement are being explored. Recently a resource-based relative-value system was enacted by Congress to correct some of the perceived inequities of Medicare reimbursement. Since reimbursement for evaluation and management services, also known as cognitive services, are based on Current Procedural Terminology (CPT-4) codes, we reviewed Medicare claims data for fiscal year 1986-87 to identify the coding habits of Connecticut urologists. We found that Connecticut urologist file 99% of their claims for cognitive services in one of six categories. Furthermore, we found that within these broad categories an average of 82% of the claims were filed under one primary practice specific code. The particular code selected, however, varied markedly between practices. Our data suggest that Connecticut urologists have adopted different standards for using CPT-4 codes and have adjusted for these differences through their fee schedules. These findings highlight the need for increased precision in CPT code definitions for cognitive services before they can be adapted to a reimbursement system based upon relative-value scales.

Abstracting and Indexing↗
PubMed1990

Connecticut emergency department physicians survey. Implications for graduate medical education.

A survey conducted in mid-1989 of 36 Connecticut hospital emergency departments sought to determine the nature of physician staffing and the volume and the acuteness of patient problems. Overall, only 31% of emergency department staffing is provided by board certified emergency physicians in the state of Connecticut. In addition to emphasizing the lack of board certified emergency physicians available in the state, this survey also indicated a relative deficiency in emergency department physician staffing in general with approximately 20% of all positions currently unfilled statewide. The implications of these findings for graduate medical education in Connecticut are discussed.

Connecticut↗
PubMed1990

Mammography in Connecticut: current estimates of capacity and usage.

All 124 registered mammography facilities in Connecticut were surveyed in 1988 to determine the availability, quality, and usage of mammography services. A total of 112 responses (90% return) were analyzed. By the measures considered here, capacity and quality of mammography in Connecticut is very good to excellent. Services are available in Connecticut in a wide array of locales, times, and settings. Since 1985, 95 new dedicated machines have been put into service. We estimate that current capacity may exceed 400,000 annual studies. Utilization is below current capacity; roughly 155,000 examinations were completed in 1988. Continued recognition of the procedure's effectiveness, particularly in screening women for evidence of early disease, can help reduce the burden of breast cancer.

Connecticut↗
PubMedDate not supplied

Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut.

Laboratory-based surveillance of Lyme disease in Connecticut during 1984 and 1985 identified 3,098 persons with suspected Lyme disease; 1,149 were defined as cases. Lyme disease incidence in Connecticut towns ranged from none to 1,407 cases per 100,000 population in 1985. A comparison of 1985 data with data from 1977 epidemiologic studies indicated that incidence increased by 129 percent to 453 percent in towns previously known to be endemic for Lyme disease and that Lyme disease had spread northward into towns thought to be free of Lyme disease in 1977. Children aged five to 14 years had the highest incidence. Of persons with Lyme disease, 83 percent had erythema migrans, 24 percent had arthritis, 8 percent had neurologic sequelae, and 2 percent had cardiac sequelae. The distribution of symptoms was age-dependent: case-persons less than 20 years old were almost twice as likely to have arthritis than older case-persons (35 percent versus 18 percent). Of persons with arthritis, 92 percent of those less than 20 years of age, compared to 68 percent of older persons, did not have antecedent erythema migrans. We conclude that Lyme disease is increasing in incidence and geographic distribution in Connecticut. Of those with Lyme disease, children may be more likely than adults to develop arthritis and have it as their first major disease manifestation.

Adolescent↗
PubMed1989

The epidemiology of Lyme disease in Connecticut.

The overall incidence for Lyme disease for Connecticut residents in 1988 was 22 per 100,000. The highest rates were among residents of New London (108 per 100,000) and Middlesex Counties (72 per 100,000), although the greatest increase in incidence between 1985 and 1988 occurred among residents of Fairfield County (2 per 100,000 in 1985, 14 per 100,000 in 1988). Lyme disease is a statewide problem; in 1988 cases were reported among residents of 104 of Connecticut's 169 towns and cities. The disease burden in some communities is high with case rates approaching 1% of the population per year. Data from 1977 and 1985 suggest a three- to eightfold increase during that period in the occurrence of Lyme disease in the communities near the mouth of the Connecticut River. Continued reporting of cases with supporting clinical information is needed to improve Lyme disease surveillance and establish disease trends.

Connecticut↗
PubMed1989

AIDS cases with no identified risk: artifact or reality? The Connecticut example.

Connecticut's 66 AIDS cases initially reported with no identified risks (NIRS) were reviewed and intensively investigated. Investigation resulted in reclassification of 45 cases (68.2%) to categories of known risk; one case (1.5%) was misdiagnosed as AIDS. Twenty cases (30.3%) remain NIRS because no risk could be established at this time. Evidence that NIRS represent reporting artifact, rather than unknown or new modes of transmission, was found. (1) NIRS are cases for which information on sexual behavior is highly sensitive or difficult to obtain. After investigation, 72% of reclassified Connecticut NIRS were determined to have risks related to sexual transmission. (2) The percentage of NIRS fluctuates according to reporting source and method of investigation. Within Connecticut, major reporting sources vary from a high of 15% to a low of 0% NIRS among their cases. The most effective method for establishing risks was to obtain information from reporting sources.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Projections of the future supply of family physicians in Connecticut: a basis for regional planning.

BACKGROUND: There is a growing consensus that there is a shortage of primary care physicians in the United States. Many proposals have been made to increase the national supply of such physicians; however, because regional physician distribution and needs are highly variable, such proposals require evaluation in light of regional physician demands. METHODS: An examination was conducted of the projected supply in the year 2002 of active, nonfederal family physicians and general practitioners (FP/GPs) involved in direct patient care on a state-by-state basis, with particular focus on Connecticut. Data on the 1992 supply and demographics of FP/GPs were obtained from the American Medical Association Physician Masterfile. These data together with residency graduation, regional retention, and interstate migration data were used to project state FP/GP supplies in 2002 by estimating additions to and losses from state supplies between 1992 and 2002. RESULTS: In 1992, Connecticut had relatively fewer and older FP/GPs than the nation as a whole. By 2002, the supply of Connecticut FP/GPs is projected to decrease by 9%. Nine other states have similar potential for a net loss of FP/GPs over the same period. CONCLUSIONS: In the context of a national shortage of primary care physicians, a decline in the supply of FP/GPs in 10 states would be undesirable. Such a decline in the number of FP/GPs in undersupplied states could be averted by increasing the number of graduates from state residency programs, importing FP/GPs from out of state, promoting retention of state FP/GPs and residency graduates, and retraining existing state physicians in family practice or primary care.

Adult↗
PubMed1995

Controlling lead toxicity in bridge workers--Connecticut, 1991-1994.

Workers involved in the repair of infrastructure--including bridges and roads--are at risk for exposure to lead and lead poisoning (1,2). Because of these risks, in 1990, the Yale University School of Medicine, the Connecticut Department of Public Health and Addiction Services (CDPHAS), the Connecticut Department of Transportation (CONNDOT), and CDC's National Institute for Occupational Safety and Health (NIOSH) initiated the Connecticut Road Industry Surveillance Project (CRISP) to reduce lead toxicity in bridge workers through the incorporation of protective measures into contracts in addition to the use of regulatory measures. This report describes an assessment of the impact of this program.

Connecticut↗
PubMed1994

Cutaneous melanoma in Connecticut towns, 1989-91.

Some 1,522 cases of invasive melanoma of the skin were diagnosed among Connecticut residents in 1989-91 and reported to the Connecticut Tumor Registry. Statistically significant excess numbers of cases (both sexes combined), relative to those expected on the basis of statewide rates, were found for residents of 11 of the state's 169 towns. Six of these 11 towns are located on the ocean shoreline and two are near the largest lake in the state. In another analysis, eight towns that are on the ocean shoreline and have a state park or large beach had a 64% excess of melanoma (ie, 151 cases vs 92.4 expected). A case-control epidemiologic study of the role of excessive sun exposure (especially at beaches) in the causation of cutaneous melanoma in Connecticut could provide further support for stronger efforts by physicians and public health agencies in the primary prevention of a cancer for which incidence rates continue to increase.

Adolescent↗
PubMed1994

Connecticut physicians' knowledge and needs assessment of environmentally related health hazards--a survey.

Health care professionals for the most part, have had little or no formal education in environmental or occupational medicine. A survey tool was created to determine the educational needs of physicians in Connecticut related to environmental medicine. The questionnaire targeted four informational areas: demographics, diagnosis of environmentally caused illnesses, knowledge of environmental hazards specific to Connecticut's Superfund sites, and preference of educational materials. Results of the survey indicated that Connecticut physicians are interested in obtaining more information about environmental hazards; that there is a need for basic information about toxic waste sites, their contaminants, and the diseases associated with them; and finally, that patients are now questioning physicians about environmental hazards, especially those popularized by the media. Clearly, physicians can play a key role in educating the public about environmental hazards.

Connecticut↗
PubMedDate not supplied

Lung cancer rates in the Hispanic population of Connecticut, 1980-88.

To identify lung cancer patients of Hispanic ethnicity, surnames in the Connecticut Tumor Registry were matched with the 1980 Spanish surname list of the U.S. Bureau of the Census. Also death certificates for women with lung cancer in the registry were examined to ascertain maiden names. For women Hispanic surnames in the registry were not good indicators of ethnicity; their sensitivity was only 58 percent when compared with the decedent's maiden name. Estimated age-specific incidence rates for lung cancer during the 1980-88 period among Hispanic men, using surnames in the registry, were lower than the rates for non-Hispanic men, as expected from studies of Hispanic mortality in the Northeast. The distribution of histologic types, including those most strongly associated with smoking, was similar for Hispanic and non-Hispanic men. Although estimated lung cancer mortality rates were low for Hispanic men defined by surname, higher standard mortality ratios for Puerto Rican-born versus other Hispanic men suggested heterogeneity in lung cancer death rates of the Hispanic population of Connecticut. Lung cancer incidence and mortality rates should continue to be monitored in the Hispanic population of Connecticut, in view of anticipated increases attributable to trends in smoking behavior, and interventions should be planned to counteract anticipated increases.

Adult↗
PubMed1993

Impact of new legislation on needle and syringe purchase and possession--Connecticut, 1992.

Human immunodeficiency virus (HIV) and other bloodborne pathogens are transmitted among injecting-drug users (IDUs) through the reuse and sharing of contaminated needles and syringes (NSs). Of the 689 acquired immunodeficiency syndrome (AIDS) cases reported in Connecticut in 1992, 413 (60%) were associated with injecting-drug use. To help reduce IDUs' use of contaminated NSs, Connecticut enacted laws effective July 1, 1992, that allow the purchase without a prescription of up to 10 NSs at one time in pharmacies and the possession of up to 10 clean NSs. Before this date, purchase and possession of NSs without a prescription had been illegal in Connecticut. This report presents preliminary information from the first 5 months of an ongoing evaluation to determine whether the new laws affected pharmacy-based NS sales, IDUs' reported knowledge of the laws and places to obtain NSs, and law enforcement officers' risk for needlestick injuries.

Connecticut↗
PubMed1996

Assessment of testing for and completeness of reporting of vancomycin-resistant enterococci--Connecticut, 1994.

From 1989 through 1993, the proportion of enterococcal isolates resistant to vancomycin (VRE) reported to CDC's National Nosocomial Infections Surveillance (NNIS) system increased from 0.3% to 7.9% (1). Since January 1994, clinical laboratories in Connecticut have been required to report all sterile-site VRE isolates to the Connecticut Department of Public Health (CDPH) to determine the epidemiology of VRE infection in the state. In 1995, CDPH surveyed all clinical laboratories in the state to identify microbiologic methods used to determine antimicrobial susceptibility of enterococcal isolates and to assess the completeness of reporting in 1994. This report summarizes the survey findings and the assessment of reporting for VRE, which confirmed for the first time that VRE infections were occurring statewide in Connecticut.

Anti-Bacterial Agents↗
PubMed1997

Trends in prostate carcinoma incidence in Connecticut (1988-1994) by age and race.

BACKGROUND: Large increases in prostate carcinoma incidence rates from 1988 to 1992, followed by sharp declines, in several U.S. cancer registries have been attributed to the impact of screening. Trends may vary by age, racial and/or ethnic group, and geography. METHODS: Trends in prostate carcinoma incidence rates between 1988 and 1994 were examined by age group and race (African American and white), using data from the population-based Connecticut Tumor Registry. RESULTS: Incidence rates for all stages combined rose from 1988 to 1992 and then declined for men age 65-74, 75-84, and 85 + years; however, as of 1994, no decline was evident for those age 45-54 and 55-64 years. Distant stage rates declined after 1991 for men age 65-74 and older, but not for younger age groups (in which increases in rates had occurred for all tumor grades among locoregional stage cancers). Trends in age-standardized rates were similar for African Americans and whites in Connecticut, but larger increases in Utah suggested regional differences in screening rates. CONCLUSIONS: Temporal trends in prostate carcinoma incidence in elderly men in Connecticut were consistent with the impact of screening, but the explanation for trends in younger men was less clear, indicating the need for continued monitoring.

Black or African American↗
PubMed1998

Trends in the incidence of upper extremity soft tissue malignancies: a 40-year review of the Connecticut State Tumor Registry.

BACKGROUND: Although soft tissue malignancies of the upper extremity are rare, the management of these lesions has been controversial and the etiologic factors associated with the occurrence of these tumors are not well understood. The purpose of this study was to identify possible epidemiologic factors related to a recently noted rise in the occurrence of these tumors in the state of Connecticut. METHODS: The occurrence of upper extremity soft tissue tumors over the past 40 years was reviewed in the Connecticut State Tumor Registry. Demographic data collected included occupational history, residence, and presence of concomitant malignancies. Tumor histology, the extent of resection, and the incidence of recurrences were also noted. Factors associated with recurrence were identified using linear regression analysis. RESULTS: During the 40-year study period, 359 patients having upper extremity soft tissue tumors were entered into the Connecticut State Tumor Registry. An increasing trend in the number of upper extremity soft tissue tumors was evident. Many patients were involved in heavy industry or related fields. Fibrosarcoma and liposarcoma were the most common tumor types, occurring in 111 (30.3%) and 48 patients (13.2%), respectively. Sixty-seven patients presented with a synchronous second primary malignancy of the breast (49 patients), lung (seven patients), or gastrointestinal tract (five patients). Most patients (69.9%) underwent local excision of the soft tissue tumors, with fewer undergoing wide excision (20.3%) or radical excision (9.7%). Recurrence, which occurred in 144 patients, was found to be associated with extent of resection, occupational history, and concomitant malignancy. Delineation of such risk factors may be helpful in identifying patients in whom aggressive management may decrease recurrence and improve survival.

Adolescent↗
PubMed1998

Public awareness of rabies and compliance with pet vaccination laws in Connecticut, 1993.

OBJECTIVE: To determine the degree of public awareness of rabies and compliance with cat and dog vaccination laws in Connecticut in 1993. DESIGN: Monthly telephone surveys. SAMPLE POPULATION: 1,810 households. PROCEDURE: A telephone interview was conducted, using rables-related questions contained in the Behavioral Risk Factor Surveillance System, with an adult member from households randomly selected statewide by telephone number. Results of the surveys for the year were aggregated, and weighted data were analyzed. RESULTS: Ninety percent of respondents had heard about rabies during the preceding year, and 84% considered it a problem in Connecticut. Forty-seven percent of households surveyed owned dogs or cats. Ninety-three percent of dogs and 80% of cats were reported to be vaccinated against rabies. Twenty-two percent of households with cats had at least 1 cat that was not current on rabies vaccination. CLINICAL RELEVANCE: In Connecticut, an epizootic of rabies in raccoons was accompanied by a high degree of awareness of rabies and rate of reported vaccination of dogs and cats. However, vaccination of cats was less common than that of dogs. Public education efforts should emphasize the necessity to vaccinate cats and to avoid contact with unknown cats in rabies epizootic or enzootic areas. A surveillance system can be used to help evaluate public health programs.

Adult↗