SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
In response to the needs of high-tech children, Vermont's Medicaid program designed a controversial system whereby the durable medical equipment company is the main service provider. Some say the program has been successful; others say it unnecessarily complicates provision of care.
Hoshin planning is a systems approach to strategic planning. It is a step-by-step process for building consensus on the vital few strategic areas within which breakthroughs must occur if an organization is to meet and exceed the needs of its customers. The seven management and planning tools are the implements of the hoshin process. They provide the means for generating, deploying, and auditing the strategic work of the organization. This tutorial describes the use of hoshin planning and the seven management and planning tools to build a strategic plan for the Vermont Academic Medical Center, including lessons learned and plans for improvement.
To impact Vermont's high breast cancer death rate, a statewide survey was conducted to identify barriers to screening. An awareness campaign was implemented that included community meetings, worksite education, television and radio ads, and physician education. A follow-up survey showed a significant increase in women ever having a mammogram and a significant decrease in women who felt that mammograms were not needed, the greatest identified barrier to screening. Despite increased awareness of breast cancer nationwide, it is likely that the education strategy successfully targeted and impacted women's behavior. Continued educational efforts are needed, particularly in women 50 and older.
In 1993, an outbreak of an unexplained pulmonary illness occurred in the southwestern United States. This outbreak led to the first description of hantavirus pulmonary syndrome (HPS), a rodentborne hantaviral infection. Hantaviruses have been found in rodents in rural areas throughout the United States, but most infection has occurred in the southwest. This report describes the first HPS case in Vermont and underscores the importance of preventing exposure to peridomestic rodents and recognizing the signs and symptoms of HPS.
Powassan (POW) virus, a North American tickborne flavivirus related to the Eastern Hemisphere's tickborne encephalitis viruses, was first isolated from a patient with encephalitis in 1958. During 1958-1998, 27 human POW encephalitis cases were reported from Canada and the northeastern United States. During September 1999-July 2001, four Maine and Vermont residents with encephalitis were found to be infected with POW virus. These persons were tested for other arbovirus infections found in the northeast after testing for West Nile virus (WNV) infection was negative. This report describes these four cases, summarizes the results of ecologic investigations, and discusses a potential association between ticks that infest medium-sized mammals and the risk for human exposure to POW virus. The findings underscore the need for personal protective measures to prevent tick bites and continued encephalitis surveillance.
Achievement of management goals for Lake Champlain (Vermont/New York, USA and Quebec, Canada) will require significant reductions of phosphorus (P) loads from agriculture, the dominant diffuse source in the basin. Cost-effective P reduction strategies must be based on reliable treatment techniques beyond basic erosion control and animal waste storage practices. The Lake Champlain Basin Agricultural Watersheds National Monitoring Program (NMP) Project evaluates the effectiveness of low-cost livestock exclusion, streambank protection, and riparian restoration practices in reducing concentrations and loads of diffuse-source pollutants from grazing land at the watershed level. Treatment and control watersheds in northwestern Vermont have been monitored since 1994 according to a paired-watershed design. Monitoring includes continuous stream discharge recording, flow-proportional sampling for total P and other pollutants, and documentation of land use and agricultural management activities. Strong statistical calibration between the control and treatment watersheds has been achieved. Landowner participation in the land treatment program was entirely voluntary and all treatments were 100% cost-shared by the project and cooperators. Installation of riparian fencing, alternative water supplies, protected stream crossings, and streambank bioengineering was completed in 1997 at a cost of less than US$40,000. The paired-watershed design was effective in controlling for the influence of extreme variations in precipitation and streamflow over six years of monitoring. Two years of post-treatment data have documented significant reductions in P concentrations and loads from both treated watersheds. Reductions of approximately 20% in mean total P concentration and approximately 20-50% in mean total P load have been observed, with greater reductions occurring in the watershed receiving more extensive treatment. The effectiveness of riparian zone restoration in P reduction tended to be lower during periods of very high runoff, especially outside the growing season.
In view of the fact that the impact of statewide smoking laws on private worksite policies and the smoking behavior of employees has not been evaluated, two cross-sectional surveys were performed in Vermont to measure compliance with such a law: a random-digit telephone survey of employees and a subsequent mail survey of their employers. Employers were not aware that one of their employees had been surveyed. Roughly half (56 percent) of the employees and 66.5 percent of their employers described policies that are in compliance. Among all employers who described policies in compliance with the law, 68.1 percent of their employees also described compliant policies. Among all employees who described non-compliant policies, 48.8 percent had employers who described compliant policies. Overall, employees and employers agreed on how their policies stood with respect to compliance in 67.6 percent of cases. The prevalence and amount of smoking at work declined after the institution of the law but so did the prevalence and amount of smoking at home. Changes toward more restrictive policies were associated with reductions in cigarette consumption at work, but not with quitting. The study suggests that a large fraction of worksite smoking policies may not comply with a statewide worksite smoking law. The proportion of companies complying with such a law may be overestimated if information on compliance is obtained only from employers.
This article describes the centrality of the nursing leadership role in Vermont's statewide efforts to combat the nursing shortage, particularly the establishment of a Blue-Ribbon Commission and an Office of Nursing Workforce Research, Planning, and Development. Recommendations by the Blue-Ribbon Commission along with its progress to date are presented. The role of the Office of Nursing Workforce Research, Planning, and Development is described in accomplishing the recommendations of the Blue-Ribbon Commission. These efforts have been cumulative, characterized by innovation and unprecedented collaboration between stakeholders representing nursing, public health, health care administration, education, and the political and private sectors. Lessons for replication are underscored.
John Snow's historic investigation of a severe epidemic of cholera traced the cause of infection to a common water source. Today, 150 years later, waterborne diseases remain a public health problem, and similar investigations are used to identify the source of infection. On February 3, 2004, the Vermont Department of Health (VDH) was notified of an outbreak of acute gastroenteritis among children whose only common exposure was attendance at a swimming club the previous weekend (January 31-February 1). This report summarizes the results of an investigation conducted by VDH and CDC, which determined the cause of the outbreak to be a combination of stool contamination, a blocked chlorine feed tube, and multiple lapses of pool-maintenance procedures. The findings underscore the importance of correct pool maintenance for rapid identification of water-quality problems to prevent outbreaks of swimming pool-associated illness.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged as a major cause of skin disease in the United States. Outbreaks of CA-MRSA have occurred among athletes, inmates at correctional facilities, and military recruits. This report summarizes investigations of six unlinked clusters of skin and soft tissue infections caused by CA-MRSA among 44 recipients of tattoos from 13 unlicensed tattooists in three states (Ohio, Kentucky, and Vermont); use of nonsterile equipment and suboptimal infection-control practices were identified as potential causes of the infections. Clinicians should consider CA-MRSA in their differential diagnosis for staphylococcus diseases, including skin infections. Clinicians can contact their local health departments to determine the prevalence of CA-MRSA in their community and whether the disease is reportable. MRSA infections should be added to education and prevention campaigns highlighting the risks of unlicensed tattooing.
Collections of mosquitoes in Vermont during 1980 and 1989 have resulted in 9 new state records, including species of Psorophora and Wyeomyia for the first time. A checklist of all species occurring in the state is also given.
The Vermont Department of Health reviewed 2,035 reports of selected notifiable diseases received from January 1, 1986, through December 31, 1987. Laboratories provided 1,160, or 71 percent, of the initial reports on 1,636 confirmed cases. This demonstrates that laboratories, when required by law and when part of active surveillance, can make a significant contribution to surveillance of infectious disease. A survey of primary care physicians indicated that 18 percent always reported notifiable diseases. The most frequently mentioned reason for lack of reporting was an assumption that the laboratory would report the cases.
The potential for overutilization of dental sealants is cited as one rationale for limitations in third-party coverage for such care. To evaluate the validity of these concerns, provider behavior was reviewed, using twelve months of claims data from one insured population with pre-existing coverage for dental sealants. A total of 13,512 procedures from Vermont's "Tooth Fairy" program for low-income children were reviewed for several variables; these related to provider, patient, procedure type, and tooth number. Although sealants were the third most frequently rendered service, only 10.5 percent of patients received sealants. Treatment was largely consistent with professional guidelines for targeting care according to patient age. The absence of excessive or unnecessary utilization, combined with evidence of caries development in older children, suggests that insurers should review the appropriateness of protocols for sealant coverage.
A mailed survey of 141 Vermont family physicians (74% participating) was conducted to determine their breast cancer screening practices and beliefs and their interest in receiving training in breast cancer screening. Of these, only 12% reported that at least three fourths of their female patients older than 50 years received mammograms at least once a year, compared with 33% who reported providing breast self-examination instruction and 35% who administered clinical breast examination with at least three fourths of these patients at least once a year. Nevertheless, 55% of the physicians rated mammography as a very effective breast-screening procedure; 28% rated breast self-examination and 16% rated clinical breast examination as very effective. Three fourths of the physicians showed great interest in learning more about breast palpation, breast self-examination instruction, and mammography. Individual instruction in the office was preferred over a group workshop format, and a trained nonphysician health professional was considered as acceptable as a physician to provide the instruction. Results suggest that breast cancer screening education for family physicians is a high priority, and that physicians will welcome such training, particularly if it is office-based.
Thirty-two confirmed and 24 highly probable cases of Legionnaires' disease occurred in Vermont between May 1 and Oct 15, 1977. Confirmed cases had positive results for direct fluorescent antibody testing of lung tissue or fourfold rise in antibody titer. Highly probable cases had one elevated titer (greater than or equal to 1:256) and a compatible illness. Forty-eight (86%) had underlying chronic disease, and 22 (39%) were immunocompromised. Prominent early symptoms were fever, cough, chills, and malaise. All but one patient had verified pneumonia. Courses ranged from a pneumonia not requiring hospitalization to respiratory failure necessitating support with mechanical ventilation. Seventeen patients died. Although the clinical presentation was variable, rapid development of high fever and leukocytosis together with negative cultures of lower respiratory tract secretions strongly suggested the diagnosis in an epidemic setting.
Fourteen fatal cases from the 1977 Vermont outbreak of Legionnaires' disease have been analyzed. Serious underlying diseases were present in all patients. The only consistent lesions were in the lungs. Bronchopneumonia was present in all cases and was confluent in most. No lobe of the lung was preferentially involved and consolidation was usually bilateral. Abscesses were evident macroscopically in only two cases. Microscopically, there was an extensive alveolar infiltrate of polymorphonuclear neutrophils and macrophages. Lysis of the inflammatory cells was frequently present and was associated with an increased number of bacteria. Coagulative necrosis of lung was present in a few cases, and the possibility of a bacterial toxin must be considered. Bacteria were well stained by the Dieterle stain and appeared Gram-negative in tissue imprints from the unfixed lung.
Identified were 1,906 cases of confirmed lung cancer that occurred among all residents of New Hampshire and Vermont over a 4-year period. Medical records, pathologists' reports, and, when possible, pathology slides were obtained and reviewed to assign cases to a specific histologic diagnosis. The diagnosis made by the original pathologist was generally confirmed upon review, except for the large cell undifferentiated cell type which appeared to be an unreliable classification. Among men at all ages incidence rates for squamous cell cancer far exceeded those for adenocarcinoma and small cell undifferentiated carcinoma, and the three age-incidence curves showed a similar pattern, rising until the eighth decade of life and then declining. Among women these three major cell types occurred about equally often, but the age-incidence curves differed in shape with adenocarcinoma reaching a peak incidence at an earlier age.
Three of four family members reported recurrent episodes of gastrointestinal illness while residing in a house in a small northwestern Vermont village. The father and two daughters repeatedly experienced episodes of emesis and abdominal pain after drinking water drawn from their kitchen faucet. One early-morning water sample taken from the family household contained a copper level of 7.8 mg/L, which is above the standard for drinking water (1.0 mg/L). Values for the second daughter's copper in hair analysis (1,200 micrograms/g) and copper in nail analysis (100 micrograms/g) were elevated (normal range 11 to 53 micrograms/g). The household was at the end of a 3/4-in (19.05-mm) copper main, and it is suspected that copper levels increased in water when the water remained stagnant in the main. All symptoms of the family resolved when they stopped drinking water in their home. This is the first report of copper-induced gastrointestinal illness attributable to a public supply of drinking water.