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From July through October 1993, outbreaks of Legionnaires' disease (LD) were reported from communities in Massachusetts and Rhode Island and from a state prison in Michigan. Cooling towers (CTs) were identified as the source of all three outbreaks. This report summarizes investigations by state and local health officials and CDC and efforts to control these outbreaks.
1. Divergent selection was undertaken in a Rhode Island Red population for residual food intake, measured in males and females, using mass selection. 2. In the absence of a control line, selection response during 14 generations was estimated by the within-year divergence between lines. 3. The direct response in residual food intake was found to be significant in both sexes, the divergence reaching almost three phenotypic standard deviations in each sex. 4. Significant correlated responses were obtained for food efficiency; it was improved in the low residual food intake line. Shank length, wattle length and rectal and comb temperature showed higher values in the high line, suggesting an increased heat production or dissipation. Inconsistent changes were observed for other egg production traits.
Experiments were conducted to compare the response of Rhode Island Reds (RIR) and White Leghorns (WL) to estradiol (E2) administration and diets of different composition. In growing chickens injected with E2 for 7 days, RIR accumulated significantly more hepatic lipid and had significantly less plasma lipid than WL. Both RIR and WL, injected for 4 days with E2, had lower hepatic lipids when fed a diet containing fish meal, alfalfa meal, and torula yeast (FAY) than when fed a corn-soybean meal diet (CS). Plasma glutamic oxaloacetic transaminase activity was significantly lower for RIR. Feeding a FAY diet to laying hens significantly reduced hepatic lipids in WL but not in RIR. Implantation of tubes containing E2 in RIR-laying hens resulted in a significant body weight loss and 25% mortality, while a similar treatment in WL-laying hens caused no body weight loss or mortality. Injecting both RIR and WL-laying hens with E2 caused a marked body weight loss and high mortality in both breeds although WL were less severely affected. The results show that breeds of chickens respond differently to both E2 administration and changes in diet composition.
A statewide survey to identify and abate spray-on asbestos hazards in schools has been conducted in Rhode Island. Of 326 target schools, 24 (8 per cent) contained material confirmed in the laboratory to be spray-on asbestos. Overt hazards requiring major corrective measures were found in 4 (1 per cent) of the target schools. Simplified identification and reporting procedures allowed for the efficient conduct of the survey.
There were 667 recorded cases of bacterial meningitis in the hospitals of Rhode Island during the ten year interval of 1976 to 1985 yielding an average annual incidence rate of 6.9 cases per 100,000 population, and a case fatality rate of 10.3%. These rates are similar to those generated in other retrospective surveys in the United States. This survey corroborates the well-established observation that bacterial meningitis is largely a disease of early childhood. But these data also suggest that meningitis in the very elderly is more common than had previously been assumed. Many of the elderly cases in this series, particularly those caused by the coliform organisms, followed shortly after body trauma or appeared in individuals burdened by disseminated cancer or diabetes mellitus.
We retrospectively reviewed the medical records on all cases of acute epiglottitis in adults from each of the hospitals in Rhode Island and from the state medical examiner's office over an eight-year period (1975-1982). We found 56 cases--an annual incidence of 9.7 cases per million adults. A significant increase occurred in the last two study years. Indirect laryngoscopy proved to be more reliable in making a diagnosis than did x-ray films of the neck; all of 41 indirect examinations were performed without complications. Twenty-three percent (6 of 26) of patients in whom blood cultures had been obtained had bacteremia, all with Hemophilus influenzae. Bacteremia was associated with a high risk of airway obstruction. Four patients died, all from acute airway obstruction, for a mortality rate of 7.1 percent--a rate significantly higher than the current rate among children. Two deaths occurred after admission, while the patients were being observed without an artificial airway. We conclude that the incidence of epiglottitis in adults is higher than previously believed and may be increasing. Fatal airway obstruction can occur without warning, indicating a need for early protection of the airway in adults as well as in children.
Population-based hospital emergency department data on motor vehicle traffic trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status. Annualized rates of overall and severe trauma were 1,195 cases (95% confidence interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000 population, respectively. Overall and severe rates peaked at ages 15-24 years. Male rate excesses were most pronounced for motor-cycle and pedal cycle trauma.
Presented are the basic design, methods, and baseline data analyses for the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR Project) an experimental study to investigate the relative effectiveness of a 12-month, stage of readiness to change-based multiple-behavior intervention (exercise and nutrition) compared to single-behavior interventions in a community-dwelling population of 1,277 older adults. Relationships between stage of readiness to change in the two target behaviors, as well as the relationship between stage of readiness and self-reported exercise levels and fruit and vegetable consumption, were examined using a combination of Pearson chi-squares, analyses of variance (ANOVA), and Spearman's rank order correlations. Stage of change (SOC) for fruit and vegetable consumption was significantly associated with the dietary measure, and SOC for exercise was associated with both the three physical activity measures and servings of fruits and vegetables per day. Overall, individual older adult's readiness to change seems largely to be behavior-specific.
From January 1, 1975 to May 1, 1982, 81 individuals died during or immediately after recreational exercise in the State of Rhode Island. Deaths occurred during a variety of activities, but the majority of deaths occurred during golf (23%), jogging (20%), and swimming (11%). Atherosclerotic coronary heart disease (ASHD) was the presumed cause of 88% of the deaths, primarily in subjects over age 29 with known cardiac abnormalities. Only 7% of ASHD victims had no relevant medical history or ASHD risk factors and were considered healthy by their families and physicians. In contrast, deaths in young subjects were rarely associated with ASHD or prior knowledge of cardiovascular disease. Only six deaths in individuals aged 29 or younger occurred during the study period. These deaths were associated with congenital cardiovascular disease (N = 2), valvular heart disease (N = 1), hemorrhagic gastritis (N = 1), idiopathic myocardial hypertrophy (N = 1), and hypertrophic cardiomyopathy with ASHD (N = 1). A diagnosis was made before death only in the individual with valvular disease. We conclude that death during recreational exercise is predominantly due to ASHD and occurs in men with recognized ASHD risk factors, relevant medical histories, or known disease. Death during exercise in asymptomatic subjects is rare and relatively more frequent in younger age groups.
Currently, professionals and parents are working collaboratively to refine and develop a seamless and effective system for screening, detection, intervention, and education in Rhode Island.
A new Occupational and Environmental Health Center has opened in Providence, Rhode Island, the successor to the one operated by Dr. David Kern until 1997 when he published research that identified a new occupational respiratory disease among patients there and thereby drew a storm of controversy involving his program, Memorial Hospital, and Brown Medical School. The new independent clinic is the result of cooperative work among a number of medical and occupational organizations in the state.
The purpose of this study is to describe the current status of academic-public mental health linkages in the State of Rhode Island by querying key informants concerning their opinions in the following areas: clinical orientation and preferred clinical interventions, specific approaches to academic-mental health linkages, training and educational opportunities, obstacles to a career working with persons who have persistent and severe mental illness, and recommendations to improve academic-mental health linkages. Forty-eight of sixty key informants, among them academics, mental health administrators, clinical practitioners and consumer advocates, responded to the mailed survey. More than half the respondents rated affective disorders, schizophrenia and substance abuse to be their highest concern as professionals; most subscribed to biological models of mental illness as well as a variety of prevailing treatment strategies employed in the care of persons with severe mental illness; generally they rated the current status of academic-mental health linkages to be low, but recommended a range of remedies to improve and increase collaborative efforts.
A patient is presented who developed an acute gastrointestinal and neurologic syndrome progressing to coma after ingestion of a fish soup made in Rhode Island. Laboratory studies confirmed the clinical diagnosis of ciguatera poisoning. Physicians should be aware of the diagnostic features of this disease even in non-endemic areas.
Innovative and effective health promotion interventions targeted on older adults within a public health framework will be increasingly important as the US population ages dramatically. The benefits of healthier lifestyles for older adults include increased functional ability and improved quality of life. The Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR) Project is a multibehavioral health promotion intervention for community-dwelling older adults focusing on increasing exercise and fruit and vegetable consumption. Intervention materials are stage-tailored for each individual, and include manuals, newsletters, expert system assessments and reports, and telephone coaching. The primary purpose of the SENIOR Project is to investigate the relative effectiveness of a multiple-behavior intervention-based on a single theoretical framework-compared to single-behavior interventions. The secondary purposes are to investigate the intervention's effects on both functional ability and general health outcomes, and how older adults move along a continuum of changing health behaviors. The Transtheoretical Model of Health Behavior Change, the conceptual framework for the SENIOR Project, was chosen for the following reasons: performance potential with older adults, individual tailoring on a stage basis, technological features, and interdisciplinary research base and community partnership.
In 1996, Harvard Pilgrim Health Care of New England (HPHC-NE) established six percent-of-premium arrangements with five Rhode Island PHOs. Each PHO received a percentage of the regional earned premium amounts for members who selected a primary care physician affiliated with it, adjusted for member demographics, benefit differences, and group size. Each of these six joint venture agreements also incorporated a per-member-per-month capitation fee. Despite improved communication between the PHOs and the plan and inpatient utilization reductions, all six joint ventures experienced losses beyond the withhold amounts during the first year of the arrangement. Factors affecting the medical utilization and financial results included market pressure on premium levels; risk pool size and adverse selection; and lack of timely, complete, and reliable financial and utilization data.
Licensed hairdressing facilities are prevalent in communities nationwide and represent a unique and promising channel for delivering public health interventions. The Rhode Island Smokefree Shop Initiative tested the feasibility of using these facilities to deliver smoking policy interventions statewide. A statewide survey of hairdressing facilities was followed by interventions targeted to the readiness level (high/low) of respondents to adopt smoke-free policies.
Twenty-three Toxorhynchites rutilus septentrionalis were collected from a tire in South Kingstown, RI, on September 15, 1993. This represents the first recorded capture of the species in Rhode Island.
This study explores recent temporal trends in HIV prevalence among women entering prison and the incidence and associated risk factors among women reincarcerated in Rhode Island. Results from mandatory HIV testing from 1992 to 1996 for all incarcerated women were examined. In addition, a case control study was conducted on all seroconverters from 1989 to 1997. In all, 5836 HIV tests were performed on incarceration in 3146 women, 105 of whom tested positive (prevalence, 3.3%). Between 1992 and 1996, the annual prevalence of HIV among all women known to be HIV-positive was stable (p = .12). Age >25 years, nonwhite race, and prior incarceration were associated with seropositivity. Of 1081 initially seronegative women who were retested on reincarceration, 12 seroconverted during 1885 person-years (PY) of follow-up (incidence, 0.6/100 PY). Self-reported injection drug use (IDU; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.1) was significantly associated with seroconversion, but sexual risk was not (OR, 1.1; 95% CI, 0.4-3.5). Incarceration serves as an opportunity for initiation of treatment and linkage to community services for a population that is at high risk for HIV infection.