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PubMedDate not supplied

Communities defining environmental health: examples from the Colorado (U.S.A.) Healthy Communities Initiative.

Communities are increasingly defining 'health' for themselves, then becoming the main actors in actions to improve their health and well being. These community members work from a broad and inclusive definition of 'health' that often incorporates environmental health as a key aspect. They also assume an ecological, or systems, viewpoint that integrates many aspects of the community that affect health and well being, including housing, health, economy, education, transportation, youth and family issues, as well as health and illness care. This paper describes a program that involves 28 large and small, urban and rural communities in the United States state of Colorado that undertook this type of community-based health improvement project. The Colorado Healthy Communities Initiative (CHCI) was designed to bring together citizens in Colorado to work collaboratively to make their communities healthier. This paper describes the program's background, including its principles, processes, and participants, then focuses on the particular aspects of environmental health that communities included in their definitions of a 'healthy community'.

Colorado↗
PubMed2000

Testing for Chlamydia and sexual history taking in adolescent females: results from a statewide survey of Colorado primary care providers.

OBJECTIVES: Little is known about the practice patterns of primary care providers as they relate to assessing risk of and screening for chlamydial infections, an important cause of preventable reproductive morbidity in young women in the United States. The present cross-sectional study was undertaken to assess levels of chlamydia testing, sexual history taking, and prevention practices by Colorado primary care physicians, nurse practitioners, and physician assistants who provide gynecologic care to adolescent females (13-19 years old). METHODS: Between July 1998 and October 1998, an anonymous, self-administered questionnaire was mailed to a 25% random sample (n = 1265) of Colorado physicians (family practitioners, internal medicine specialists, obstetrician-gynecologists, and pediatricians), nurse practitioners, and physician assistants. Practitioners were identified through professional organization membership, state-licensing bodies, and listings in the yellow pages. RESULTS: After estimating the eligibility rate among non-respondents, the adjusted response rate was 71.5%. Only 53.8% of providers reported regularly testing sexually active female adolescents for chlamydia; 71.8% of providers regularly took a sexual history. Female providers reported significantly higher levels of regularly taking a sexual history (87. 2% vs 60.6% of males), feeling comfortable discussing sex (94.4% vs 77.8%), discussing sexually transmitted disease (STD) prevention (81. 5% vs 71.3%), and testing for chlamydia (64.4% vs 38.6%). Among provider types, obstetrician-gynecologists, nurse practitioners, and pediatricians were most likely to report regularly taking a sexual history (90.1%, 88.6%, and 76.0%, respectively). Internal medicine specialists were the least likely to report taking a sexual history (43.9%). Pediatricians and nurse practitioners were the most likely to report testing sexually active adolescent females for chlamydia (74.1% and 70.1%, respectively), whereas physician assistants and internal medicine specialists were the least likely (46.0% and 38.5%, respectively). In multivariate analysis, variables independently associated with regularly taking a sexual history included female provider gender (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 2.9-10.9), obstetrics/gynecology specialty (OR: 4.0; 95% CI: 1.7-10. 3; referent group: family practitioners), and provider comfort level in discussing sex (OR: 4.9; 95% CI: 2.3-11.1). Variables independently associated with regularly testing adolescent females for chlamydia included female provider gender (OR: 2.8; 95% CI: 1. 6-4.8), regularly discussing STD prevention (OR: 2.1; 95% CI: 1.1-4. 1), and regularly discussing limiting the number of patients' sex partners (OR: 2.4; 95% CI: 1.4-4.1). CONCLUSIONS: Only a little over one half of providers (54%) reported regularly performing chlamydia tests on adolescent females who are sexually active by history. Because this falls well short of the recommendations of the Centers for Disease Control and Prevention to test all sexually active female adolescents, efforts are needed to improve STD clinical practices of Colorado physician and nonphysician providers of primary care for adolescent females. Particular efforts are needed to close the provider gender gap.

Adolescent↗
PubMed2006

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States.

BACKGROUND: There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes. OBJECTIVE: The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved. METHODS: We conducted a retrospective comparison of hospitalization-related outcomes for children < 18 years of age in Colorado from 1995-2003 and in the United States in 2000. Population-based rates for hospital admission were determined stratified by age, race/ethnicity, disease grouping, and health insurance status. RESULTS: Compared with those with private insurance, children in Colorado and the United States with public or no insurance have significantly higher rates of total hospital admission, as well as admission for chronic illness, asthma, diabetes, vaccine-preventable disease, psychiatric disease, and ruptured appendix. These children have higher mortality rates, higher severity of illness, are more likely to be admitted through the emergency department and have significantly higher hospital charges per insured child. Higher hospitalization rates occur in children who are nonwhite and/or Hispanic and those who are younger. If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved. CONCLUSIONS: There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children.

Adolescent↗
PubMed2007

Field history and dissipation of atrazine and metolachlor in Colorado.

Farmers in eastern Colorado have commented that atrazine does not provide the length of weed control that they expected in fields that have received multiple applications of the herbicide. Multiple laboratory studies suggest that atrazine dissipates more rapidly in soils with a history of atrazine use compared with soils that had not been treated with the herbicide and this could be related to the above observation. Field and laboratory studies were conducted to determine the rate of dissipation of atrazine and metolachlor in fields in Colorado. The published half-lives of atrazine and metolachlor are 60 and 56 d, respectively. In the field studies, the half-lives of atrazine and metolachlor in the top 15 cm of the soil ranged between 3.5 and 7.2 d and 17.9 and 18.8 d, respectively. In laboratory studies, the half-life of atrazine varied from 1.4 to 19.8 d with the shortest half-life occurring in soils which had been treated with atrazine for at least 5 yr. The longest half-life was in a soil that had never received atrazine. The half-life of metolachlor in these same soils varied from 10.6 to 28.2 d. There was no apparent relationship between the half-life of metolachlor and the half-life of atrazine in the laboratory studies. These results confirm farmers' observation of the shorter residual activity of atrazine in Colorado fields receiving atrazine over multiple years.

Acetamides↗
PubMedDate not supplied

Colorado IDDM Registry: lower incidence of IDDM in Hispanics. Comparison of disease characteristics and care patterns in biethnic population.

The Colorado IDDM Registry identifies newly diagnosed cases of insulin-dependent diabetes mellitus (IDDM) throughout the state. Hispanics in Colorado are a racial mixture of American Indian and White populations. Because American Indians have a low risk of IDDM, and differing frequencies of HLA antigens and haplotypes are reported for Hispanics and non-Hispanics, we compared incidence rates and disease characteristics. Eligible participants were less than 18 yr of age and Colorado residents at time of diagnosis, diagnosed between 1 January 1978 and 31 December 1983, and on insulin within 2 wk of diagnosis. Subjects were reported by their physicians, and statewide validation of reporting was conducted through review of hospital discharge indexes. Incidence rates for Hispanics (n = 76) were significantly lower than those for non-Hispanics (n = 628), although 95% confidence intervals overlapped for children aged 10-17 yr. Age-adjusted rates were significantly lower in Hispanic than non-Hispanic males, whereas age-adjusted rates for females did not differ. The cumulative risk of IDDM was less for Hispanic males aged 0-17 yr than for non-Hispanic males (P less than .001); cumulative risk among females was males (P less than .001); cumulative risk among females was not different (P = .10). Clinical onset characteristics and medical care at diagnosis were similar. After diagnosis, hospitalizations per 100 person-yr appeared higher in Hispanics, but ketoacidosis and insulin reactions per 100 person-yr were similar. Difference in rate of hospitalizations may have been due to lower response rates among older non-Hispanics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Isolation of Tete serogroup bunyaviruses from Ceratopogonidae collected in Colorado.

Two viruses were isolated from ceratopogonid midges collected in northern Colorado. Electron microscopy indicated that both isolates were bunyavirus-like. Indirect fluorescent antibody and serum dilution-plaque reduction neutralization tests showed that these isolates were members of the Tete serogroup, most closely related antigenically to Tete and Batama viruses but distinguishable from both and from each other. We suggest the name Weldona virus for these isolates. Antibody in both waterfowl and passerine birds in northern Colorado indicates the enzootic presence of these viruses in northern Colorado and raises unanswered questions about the introduction and establishment of Tete serogroup viruses in the Americas.

Animals↗
PubMed2002

Retrospective study of morbidity and mortality of raptors admitted to Colorado State University Veterinary Teaching Hospital during 1995 to 1998.

A retrospective study was conducted to identify causes of morbidity and mortality of free-living raptors in northeast Colorado and the surrounding areas of Nebraska and Wyoming. The study included 409 raptors, representing 23 species, admitted to the Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado, USA, from 1995 to 1998. Causes of morbidity and mortality were identified as trauma (66.3%), orphaned young (15.6%), unknown (9.0%), infectious disease (4.4%), metabolic and nutritional disease (2.2%), toxicosis (2.0%), and degenerative disease (0.5%). Trauma was the most frequent cause of morbidity and mortality for all species and during all seasons.

Animals↗
PubMed1999

Blastomycosis acquired occupationally during prairie dog relocation--Colorado, 1998.

On August 31, 1998, two suspected cases of fungal pneumonia were reported to the Boulder County (Colorado) Health Department (BCHD). Both patients were immunocompetent, otherwise healthy adults working for the City of Boulder Open Space (CBOS) program on a prairie dog relocation project. This report summarizes the epidemiologic investigation by BCHD, the Colorado Department of Public Health and Environment, and CDC; the findings indicate that these two persons acquired blastomycosis in Colorado, which is outside the area where the disease is endemic.

Adult↗
PubMed1990

Colorado group develops aid for documentation.

The Colorado Peer Review Organization (PRO), the Colorado Foundation for Medical Care, has implemented the PROMPTER concept in an effort to assist physicians in charting information essential to PRO review. The examples that follow are adapted from those widely distributed in Colorado by the PRO and sent to all PRO medical directors.

Colorado↗
PubMed1999

Back pain among persons working on small or family farms--eight Colorado counties, 1993-1996.

In the United States, work-related back pain often results in lost wages, reduced productivity, and increased medical costs. However, national surveillance data about these injuries, such as occupationally acquired back pain among workers on small or family farms, are limited. To characterize back pain in a farming population, researchers at Colorado State University interviewed adult farmers residing in eight northeastern Colorado counties (Larimer, Logan, Morgan, Phillips, Sedgewick, Washington, Weld, and Yuma) during 1993-1996, using the Colorado Farm Family Health and Hazard Survey (CFFHHS). This report summarizes the findings of CFFHHS, which indicate that back pain is common among farmers and most frequently attributed to repeated activities (RAs) (e.g. lifting, pushing, pulling, bending, twisting, and reaching).

Adult↗
PubMed1999

Mandated human services restructuring: a case study in local collaboration from Colorado.

The Colorado State Legislature has undertaken an historic restructuring of human services ranging from child welfare, mental health, and nursing services to substance abuse prevention, institutionalization, and health care financing. Significant steps in this process include an overhaul of child welfare legislation, major revisions to legislation affecting group health insurance policies, and a restructuring of the state departments that provide human services. A Democratic Governor and a Republican-dominated legislature have worked together hand-in-hand, although not always harmoniously, in moving these changes forward. This article examines the statewide restructuring of human services in a case study of how the local planning process was carried out in one region of Colorado. A highlight of the case study is the Working Together survey administered to participants of the planning committee midway through the process and again after the Local Area Plan was developed. In addition, lessons are presented from the process instructive for others considering whether to undertake significant organizational restructuring. The lesson section focuses on the local area planning process and how Colorado may have designed and facilitated a more effective process.

Colorado↗
PubMed2006

The implementation of managed behavioral healthcare in Colorado and the effects on older Medicaid beneficiaries.

BACKGROUND: One of five persons over the age of 65 experiences a diagnosable form of mental illness. Yet their access to and use of specialty services are the lowest among all age groups. It is unclear how managed behavioral healthcare has affected this problematic situation. The Colorado Medicaid Mental Health Capitation Pilot Program, implemented in 1995, provided an opportunity to investigate the impact of managed behavioral healthcare on older Medicaid beneficiaries. STUDY AIMS: This study compared two capitated administrative models of Medicaid mental health service delivery to a traditional fee-for-service model, and specifically focused on how these models shaped service use and expenditure patterns for Medicaid beneficiaries over the age of 65. METHODS: This study employed a quasi-experimental, pre-post design with a non-equivalent comparison group that reflects the implementation of capitation financing in some parts of Colorado and not others. A difference in difference specification was used to identify the effects of capitation under two administrative models relative to areas remaining under fee-for-service reimbursement. Logistic and Ordinary Least Squares regression were used to estimate service use and (logged) expenditures per repeat and total number of service users. Generalized corrections for heteroskedasticity and repeated observations were applied. Probabilities and average user expenditures were derived from regression results with a fixed case-mix and compared to actuals. RESULTS: The analyses indicated that one of the capitated administrative models increased the total number of older beneficiaries who used services while the total number of service users decreased in the other capitated models. Both capitated models reduced repeat use and expenditures for specialty mental health services relative to the traditional FFS model. DISCUSSION: Capitation had the expected effect of reducing the duration and intensity of treatment. Clear differences between the two capitated administrative models emerged that appeared consistent with their management philosophies. Measured effects were limited to services covered by capitation and may have been influenced by the observational design. Overall results were somewhat different from those pertaining to younger populations studied in Colorado. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: While capitation clearly reduced total expenditures for older beneficiaries, its influence on specific treatment process measures such as user expenditures, repeat users and total users may vary considerably across treatment systems. Notably, capitation may result in increases or decreases in total users within a specific sub-population such as elders. IMPLICATIONS FOR HEALTH POLICIES: This analysis provides critical information for those state mental health and Medicaid agencies that are expanding the application of managed behavioral healthcare within a demographic environment where the population of older adults with mental illnesses is increasing. Financing, organization and their impact on specific treatment populations need to be considered in developing and applying managed behavioral health care. IMPLICATIONS FOR FURTHER RESEARCH: The differential effects on elders by administrative models needs further explication and should be measured against clinical and social outcomes as well as the effect of other sources of financing and service substitution.

Aged↗
PubMed1991

Prevalence of circulating heartworm antigen in dogs in northeastern Colorado.

Heartworm antigenemia was evaluated and found to be negative in 1010 dogs in Northeastern Colorado that were examined at the Colorado State University Veterinary Teaching Hospital. The estimated prevalence of canine heartworm for the native Northeastern Colorado population was determined to be 0.3% and is similar to the prevalence reported 10 years ago in the same area. We conclude there has not been an increase in prevalence of heartworm in the last 10 years; because of the low prevalence, there is no need for routine testing or testing and prophylaxis in the study area at this time.

Animals↗
PubMed1988

Impact of home infusion therapy on the Colorado Medicaid program budget.

The impact of home infusion therapies on the pharmaceutical services drug budget of the Colorado Medicaid program was evaluated retrospectively. Pharmacy billing claims and prior authorization forms for home infusion therapies submitted to the Colorado Department of Social Services during a 26-month period were reviewed to determine the costs of the drug or hydration solutions and ancillary products necessary for the preparation and administration of the solutions. A dispensing fee of +3.40 per dose was figured into calculations of total costs of home infusion therapies, and an estimated cost of +100-+150 per day for follow-up care was added. Equivalent costs of hospitalization were calculated using an average per diem charge of +315. A total of 61 patients received 1361 days of home infusion therapy during the study period. The majority of patients received home antimicrobial therapy; 752 days of hospitalization theoretically were avoided because of home administration of antimicrobial agents, which translates into a cost savings of +76,716-+114,316. Patients also received home parenteral nutrition therapy, analgesic therapy, and rehydration therapy that yielded cost savings of +48,374-+78,824 but in some cases resulted in higher costs than hospitalization would have. Home infusion therapies increased pharmaceutical services costs by +99,475, representing an important shift of costs from the hospital services budget to the pharmaceutical services budget. Home infusion therapies generally incur lower costs than would be incurred during an equivalent hospital stay. The Colorado Medicaid budget should be adjusted to compensate for the shift of costs from hospital to pharmaceutical services.

Anti-Infective Agents↗
PubMed1988

Establishment of the Colorado Physician Health Program with a legislative initiative.

The Colorado Physician Health Program, a statewide peer health assistance program for physicians, has been developed as a not-for-profit, freestanding corporation through the cooperative efforts of organized medicine. A recently enacted Colorado statute provides for funding through a surcharge on physician licensure fees. The use of an employee assistance model has minimized potential conflicts of interest and allowed the program to assist both physicians and the Colorado Board of Medical Examiners.

Colorado↗
PubMed1985

Migration of the elderly from high altitudes in Colorado.

The reason for the reported decline in the proportion of elderly (greater than 60 years) persons at high (greater than 2,456 m) compared with low altitude (less than 1,376 m) in Colorado was unknown. We hypothesized that adverse effects of high altitude on the elderly, particularly those with heart and lung diseases, prompted their migration to lower elevations. Colorado census data indicated that selective out-migration occurred from high to low altitude among the elderly. Interviews (n = 833) in high- and low-altitude Colorado towns revealed that the elderly were unique in that they moved down for reasons of poor health and that for the majority (81%) ill health meant heart and lung diseases. Elderly migrants from high altitude reported heart and lung diseases more frequently than those remaining and cited improvement in symptoms at low altitude. We suggest that symptoms of heart and lung disease are exacerbated with advancing age at high altitude and influence choice of residence.

Aged↗
PubMedDate not supplied

Case mix and surrogate indicators of quality of care over time in freestanding and hospital-based nursing homes in Colorado.

Broad case mix and surrogate indicators of quality of care were examined to assess (a) annual variations in these factors in Colorado's nursing homes over a 3-year period and (b) differences between hospital-based and freestanding nursing homes in the State. The findings pertain to 19 hospital-based and 138 freestanding nursing homes, and they are based largely on analyses of secondary data that were self-reported by nursing home staffs and collected through facility-level surveys conducted by the Colorado Professional Standards Review Organization and the Colorado Department of Health. The results suggest that case mix and quality change little from one year to the next for nursing homes. Based on the relatively crude case mix and quality indicators analyzed, there appears to be some evidence to suggest that case mix may be more complex and quality of care better in hospital-based nursing homes than in freestanding nursing homes. Further verification of the results, however, requires more refined measures of case mix and quality of care.

Adult↗
PubMed1995

Colorado pediatricians' involvement in community activities.

To determine Colorado American Academy of Pediatrics (AAP) pediatricians' involvement in community-based activities and awareness of and interest in the AAP Community Access to Child Health (CATCH) program, a 22-item survey was mailed to all general pediatrician AAP fellows and candidate fellows practicing in Colorado (n = 434). The return rate was 65%. Of the respondents, 73% provide direct patient care as their primary professional activity, 58% reported either current or past involvement in community-based programs outside of their practices, 91% of this community-based work was voluntary, and 80% of the respondents described this work as moderate to very rewarding. Half of the respondents (51%) were aware of the AAP CATCH program, and 68% were interested in attending a statewide CATCH meeting. We conclude that Colorado AAP pediatrician survey respondents participate heavily in community programs outside of their clinical practices and that among this group there is substantial interest in the AAP CATCH program.

Adult↗