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PubMed1999

Antibodies to granulocytic ehrlichiae in white-footed and cotton mice in eastern United States.

Serum samples, collected from Peromyscus leucopus (white-footed mouse) or Peromyscus gossypinus (cotton mouse) during 1987 through 1990 in Florida, Georgia, Maryland, Mississippi, and North Carolina (USA), and in 1997 in southern Connecticut were analyzed by indirect fluorescent antibody (IFA) staining methods or Western blot procedures for antibodies to granulocytic ehrlichiae. Of the 82 sera from white-footed mice in Connecticut tested by IFA methods with either the BDS or NCH-1 strain of the human granulocytic ehrlichiosis (HGE) agent, 45 (55%) and 42 (51%) of the samples contained antibodies to these strains, respectively, at concentrations ranging from 1:80 to 1:2560. One (2%) of 43 sera from P. leucopus captured in Assateague Island (Maryland) had a titer of 1:80, while three (20%) of 15 sera from P. gossypinus, captured in Sapelo Island (Georgia) and four (40%) of 10 sera from cotton mice caught in Amelia Island (Florida) had antibodies to the NCH-1 strain at titers of 1:160 to 1:1,280. Fifty-five sera from P. leucopus in Cape Hatteras (North Carolina) and 30 sera from P. gossypinus in Mississippi were negative. Western blot analyses confirmed seropositivity for 19 (95%) of 20 mouse sera positive by IFA staining methods, including samples from both mouse species captured in Connecticut, Maryland, or Florida. There were key banding patterns to proteins having molecular masses of about 44, 80, 105, 110, or 120 kDa. Both serologic assays can be used to determine if mice have been exposed to granulocytic ehrlichiae. These rodents also may be useful in surveillance programs to identify endemic sites for HGE and in performing laboratory studies on immune responses to the etiologic agent.

Animals↗
PubMed1999

Consensus theory model of AIDS/SIDA beliefs in four Latino populations.

To describe Latino beliefs about AIDS (SIDA), Latino adults were sampled at two U.S. sites (Connecticut and Texas) and two international sites (Mexico and Guatemala). A 125-item questionnaire covered risk factors, symptoms, treatments, and sequellae of AIDS. The cultural consensus model was used to determine the cultural beliefs for each sample. Responses from 161 people indicated that a single set of beliefs was present at each site and that beliefs were shared across sites. Comparison of answers between samples indicated high agreement (p < .0007). The proportion of shared beliefs, however, decreased significantly between samples: .68 in Connecticut, .60 in Texas, .51 in Mexico, and .41 in Guatemala (p < .05). The proportion of positive answers similarly decreased from Connecticut to Guatemala (p < .001). Beliefs were stronger and more detailed in the higher prevalence areas. Furthermore, Latino beliefs tended to converge on biomedical beliefs about the disease.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Raising the bar: the importance of hospital library standards in the continuing medical education accreditation process.

The Connecticut State Medical Society (CSMS) reviews and accredits the continuing medical education (CME) programs offered by Connecticut's hospitals. As part of the survey process, the CSMS assesses the quality of the hospitals' libraries. In 1987, the CSMS adopted the Medical Library Association's (MLA's) "Minimum Standards for Health Sciences Libraries in Hospitals." In 1990, professional librarians were added to the survey team and, later, to the CSMS CME Committee. Librarians participating in this effort are recruited from the membership of the Connecticut Association of Health Sciences Librarians (CAHSL). The positive results of having a qualified librarian on the survey team and the invaluable impact of adherence to the MLA standards are outlined. As a direct result of this process, hospitals throughout the state have added staffing, increased space, and added funding for resources during an era of cutbacks. Some hospital libraries have been able to maintain a healthy status quo, while others have had proposed cuts reconsidered by administrators for fear of losing valuable CME accreditation status. Creating a relationship with an accrediting agency is one method by which hospital librarians elsewhere may strengthen their efforts to ensure adequate library resources in an era of downsizing. In addition, this collaboration has provided a new and important role for librarians to play on an accreditation team.

Accreditation↗
PubMed2002

Best practices in hospital end-of-life care.

The Connecticut Best Practices in End-of-Life Care project was initiated in response to the concern that Connecticut hospitals were not meeting the needs of dying patients. The records of 420 patients with a diagnosis of cancer or with an admission to an intensive-care unit were reviewed for the period 04/01/2000 to 03/31/2001. Utilizing a chart extraction tool, measures of "best practice" were developed as a means of assessing the quality of end-of-life care provided to the patient cohort. Some of the findings on the "best practice" indicators were as follows: 65 (15.3%) of the patient cohort died during their hospital stay. Three hundred forty (81.3%) had a pain assessment on admission. Three hundred eighty-six (92.6%) had a pain assessment on at least one occasion during their hospital stay. Two hundred forty-two of 397 (61%) patients who received an analgesic medication had their pain reassessed within fours hours of receiving the medication. One hundred ninty-five (46.4%) patients had their prognosis discussed with them. Eighteen patients (< 5%) were referred to hospice. Connecticut hospitals are doing well in assessing patient pain. However, they are doing poorly in discussing prognosis with sick patients and referring them to hospice.

Benchmarking↗
PubMed1976

The epidemiology of primary intracranial neoplasms of childhood. A population study.

All primary intracranial neoplasms diagnosed between 1935 and 1964, inclusive, in the well-defined populations of children under age 15 residing in the state of Connecticut and the city of Rochester, Minnesota, formed the basis for this study. The tumors occurring in this group were characterized by histologic type and by the patient's sex and the age when the tumor occurred. In Connecticut, over the 30-year period, a primary intracranial neoplasm was diagnosed in 380 patients in a mean population of 582,286 children, yielding an average annual incidence rate of 2.17 cases/100,000 population per year. Of the microscopically confirmed tumors, the most common, in order, were medulloblastoma (24.2%), astrocytoma (20.6%), glioblastoma (20.3%), ependymoma (6.5%), craniopharyngioma (5.6%) and meningioma (4.6%). These figures contrast sharply with the corresponding frequency of these tumors in the adult Connecticut population. In Rochester during the same years, 12 primary intracranial neoplasms occurred in a mean population of 7,981 children, yielding an average annual incidence rate of 5.01 cases/100,000 population per year.

Adolescent↗
PubMed2005

The Medical Examining Board speaks on pain management: everyone should listen.

PURPOSE: To alert physicians to the Statement of the Connecticut Medical Examining Board on the Use of Controlled Substances for the Treatment of Pain and provide a historical account of events leading to the promulgation of the Statement. FINDINGS: Studies conducted over the past five years have identified issues on pain control requiring attention. Established medical organizations and regulatory boards in Connecticut are attempting to address patient needs for treatment of pain while clarifying expectations of physicians, thereby reducing the likelihood of inappropriate pain treatment and licensing sanctions. CONCLUSION: All physicians should read and become familiar with the Statement of the Connecticut Medical Examining Board on the Use of Controlled Substances for the Treatment of Pain.

Analgesics, Opioid↗
PubMed1989

The conviction to care. The McKinney Scholarship Fund.

In response to the AIDS crisis and the critical need for competent and trained health care providers for the growing number of persons with AIDS, the McKinney Scholarship Fund has been recently established with the Stewart B. McKinney Foundation, and will be announced in December. As the first fund of its kind in the country, the McKinney Scholarship Fund will provide funding and financial assistance to qualified individuals who have demonstrated the ability and desire to go to school to work in the medical field with persons with AIDS, but who cannot afford to do so. At the present time, it is sponsored and endorsed by the Connecticut State Medical Society, the Hartford County Medical Association, the Connecticut Nurses' Association, the Hartford County Bar Association, and the Insurance Association of Connecticut.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Introduction to the study of multiple primary cancers.

To lay the groundwork for subsequent chapters in this monograph of multiple primary cancers in Connecticut and Denmark, we present a description of the historical significance of previous studies, focusing on key surveys that have enhanced our understanding of the origins of multiple cancers. Case reports, hospital series, and cancer registry studies have progressively sharpened our perspective on the patterns and causes of multiple cancers. These findings in turn have generated hypotheses about host and environmental determinants of various combinations of cancer and have provided clues to the actual mechanisms of carcinogenesis. The registries of Connecticut and Denmark which began in the 1930s and 1940s, respectively, afford investigators a unique opportunity to analyze the cancer experience of well-defined populations, followed for long periods. The major contribution of this monograph is the evaluation of second cancer risks among long-term survivors of cancer, including relatively rare tumors about which little information currently exists. For patients with a particular cancer, the number of observed second cancers are tabulated over time and compared with those expected if the patients experienced the same rates prevailing in the corresponding general population. We have discussed problems in distinguishing statistical artifacts from biologically plausible associations in light of the potential biases inherent in follow-up surveys of cancer patients; for example, heightened medical surveillance and mistaken metastases could result in false indications of elevated risk. Several differences in the reporting, follow-up, and coding practices between the Connecticut and Denmark registries are described and probably account for many differences in the reported findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Connecticut↗
PubMed1995

A population-based study of severe firearm injury among children and youth.

BACKGROUND: Firearm injuries are a major cause of pediatric mortality and morbidity in the United States. To date, population-based studies describe the epidemiology of firearm-related deaths; however, the patterns of severe, nonfatal pediatric firearm-related injuries are not as well defined. OBJECTIVES: To determine the epidemiology of severe firearm-related deaths and injuries among a statewide population of children and youth ages birth to 19 years. METHODS: Demographic, geographic, and cost data were analyzed from Connecticut death certificates for 1988 through 1992 and hospital discharge data for 1986 through 1990 for firearm-related unintentional, self-inflicted, and assaultive injury among children and youth ages birth to 19 years. RESULTS: There were 219 firearm deaths: 68% homicides, 25% suicides, 6% unintentional, and 1% of undetermined intent, resulting in an annual age-specific death rate of 6.6 per 100,000 persons. There were 533 hospitalizations for gunshot wounds (16 per 100,000); 41% were assaults, 1% suicide attempts, 39% unintentional gunshot wounds, 1% legal interventions, and 18% of undetermined intent. More than 80% of deaths from gunshot wounds and hospitalizations occurred among 15- to 19-year-old males, most occurring in Connecticut's five largest cities. Most firearm homicides occurred among urban residents; most firearm suicides occurred among nonurban residents; and unintentional shootings were evenly distributed between urban and nonurban residents. The total cost of firearm-related hospitalizations averaged $864,000 per year. CONCLUSIONS: Firearms are a major cause of mortality and morbidity of Connecticut children and youth, exceeded only by motor vehicles as a cause of death among those 1 to 19 years of age. Handguns were responsible for a disproportionate amount of trauma compared with other firearm types. The epidemiology of pediatric gunshot injuries requires a range of strategies for prevention. Physicians caring for families with children must include firearm injury prevention counseling as a routine part of anticipatory guidance.

Accidents↗
PubMed1994

Adolescent contraceptive counseling and gynecology: a deficiency in pediatric office-based care.

With the large and increasing numbers of sexually active adolescents, pediatricians must learn to deal with the issues of adolescent pregnancy and sexually transmitted diseases (STD). This is particularly true at a time when health care reform will encourage primary care physicians to assume a greater role in general medical management of their patients. One hundred Connecticut general practice pediatricians were randomly selected to examine the frequency, level of comfort, and rationale for involvement regarding sexual history taking, contraceptive counseling, and performance of pelvic examinations. This represents 9% of all Connecticut pediatricians. The response rate was 54%. The results were as follows: Seventy-nine percent of responding pediatricians counseled on STDs, 39% counseled on family planning, and only 62% almost always took a sexual history from the their adolescent patients, ages 10 and up. Thirty-one percent of respondents stated they would refer a male inquiring about contraception to a family planning clinic. Thirty-eight percent never do pelvic examinations on their sexually active adolescent patients. Connecticut pediatricians are providing adolescents with counseling on other high-risk behaviors such as drug and alcohol use, but provide inadequate care related to adolescent sexual activity.

Adolescent↗
PubMed1994

Age-period-cohort modelling of large-bowel-cancer incidence by anatomic sub-site and sex in Denmark.

In a previous investigation, statistical modelling was used to examine the relationship between large-bowel-cancer incidence and age, time period and birth cohort by anatomic sub-site and sex, using data from the Connecticut Tumor Registry (CTR) for the period 1950 to 1984. This analysis revealed differences in age-period-cohort patterns that suggested etiologic distinctions among sub-site groupings and between the sexes. To test the generalizability of the Connecticut findings, we have conducted a similar age-period-cohort analysis using data from the Danish Cancer Registry (DCR) for the period 1953 to 1987. Cancers of the large bowel were classified into 6 anatomic sub-sites: cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum. Data were fitted to log-linear age-period-cohort models. If we interpret differences in age-period-cohort patterns as reflecting etiologic distinctions, the Denmark analysis, in conjunction with the Connecticut findings, was consistent with there being etiologic distinctions between cancers of the colon vs. the rectum in both males and females, between cancers of the cecum and the ascending colon vs. the remainder of the colon in females and between males vs. females for cancers of the sigmoid colon and rectum. Cancers of the cecum and the ascending colon were the most similar between males and females. Due to the ambiguities of age-period-cohort modelling, these should be considered only tentative conclusions that can be tested by analytical epidemiologic studies.

Adult↗
PubMed2006

Hospital-based factors predict outcome after carotid endarterectomy.

OBJECTIVE: Patient, hospital, and surgeon factors affect outcome after carotid endarterectomy (CEA). The nature and importance of hospital-specific factors, especially those unrelated to procedural volume, that affect post-CEA outcome remains poorly defined. We used a statewide database to determine the impact of several hospital-associated factors on outcome after CEA. METHODS: Hospital factors were established by telephone survey and validated by repeated survey as well as by the Connecticut Hospital Association, Connecticut state, and individual hospital internet Websites. All CEA in Connecticut non-federal hospitals between 1991 and 2002 were examined, including perioperative mortality, stroke, and cardiac complications. Multivariable logistic regression was used to analyze data. RESULTS: There were 14,288 CEAs performed with 0.5% mortality, 1.3% stroke, and 2.4% cardiac complications. The only hospital factor independently predictive of perioperative mortality was few number of hospital beds (less than 132 beds; odds ratio (OR) 2.78, P = 0.032). Factors predictive of perioperative stroke included few number of beds (OR 1.96, P = 0.001) and absence of a critical pathway (OR 1.39, P = 0.038). Factors predictive of perioperative cardiac complications included few number of beds (OR 3.01, P = 0.003), absence of a critical pathway (OR 1.50, P = 0.001), and absence of dedicated vascular recovery beds (OR 1.35, P = 0.03). Combined mortality, stroke, or cardiac complications were independently predicted by few hospital beds (OR 4.58, P = 0.002), absence of a critical pathway (OR 1.81, P < or = 0.0001), or inability to perform cardiac angiography (OR 3.92, P = 0.024). CONCLUSIONS: Hospital-based factors, such as greater bed capacity, use of critical pathways, ability to perform cardiac angiography, or presence of a dedicated vascular recovery unit predict reduced perioperative mortality, stroke and cardiac complications from CEA. These results suggest that hospital-associated factors do impact surgical outcome and that surgeons need to optimize these factors, extrinsic to the patient and surgeon, to provide maximal quality of care.

Endarterectomy, Carotid↗
PubMed2001

A water extraction, static headspace sampling, gas chromatographic method to determine MTBE in heating oil and diesel fuel.

A method was developed to determine the fuel/water partition coefficient (KMTBE) of methyl tert-butyl ether (MTBE) and then used to determine low parts per million concentrations of MTBE in samples of heating oil and diesel fuel. A special capillary column designed for the separation of MTBE and to prevent coelution and a gas chromatograph equipped with a photoionization detector (PID) were used. MTBE was partitioned from fuel samples into water during an equilibration step. The water samples were then analyzed for MTBE using static headspace sampling followed by GC/PID. A mathematical relationship was derived that allowed a KMTBE value to be calculated by utilizing the fuel/water volume ratios and the corresponding PID signal. KMTBE values were found to range linearly from 3.8 to 10.9 over a temperature range of 5-40 degrees C. This analysis method gave a MDL of 0.7 ppm MTBE in the fuel and a relative average accuracy of +/-15% by comparison with an independent laboratory using purge and trap GC/ MS analysis. MTBE was found in home heating oil in residential tanks and in diesel fuel at service stations throughout the state of Connecticut. The levels of MTBE were found to vary significantly with time. Heating oil and diesel fuel from terminals were also found to contain MTBE. This research suggests thatthe reported widespread contamination of groundwater with MTBE may also be due to heating oil and diesel fuel releases to the environment. used extensively for the past 20 years as a gasoline additive (up to 15 wt %) to reduce automobile carbon monoxide and hydrocarbon emissions. The fact that MTBE is highly soluble in water (approximately 5 wt %) (3) and chemically inert when compared to other fuel constituents causes it to be often detected at high concentrations in groundwater in the vicinity of gasoline spills. The EPA has reported that low levels of MTBE in drinking water (above 40 microg/L) may cause unpleasant taste and odors and has designated MTBE as a possible human carcinogen (4). Past studies have concentrated on the reporting of MTBE levels in groundwater near gasoline spills. Happel et al. reported an MTBE occurrence rate of approximately 78% at locations where hydrocarbons have impacted groundwater (5). Johnson et al. estimate that 9,000 leaking underground fuel tanks have caused MTBE contamination at community water supplies in the 31 states surveyed (excluding California and Texas) (6). Robbins et al. reported finding a significant number of MTBE detections in groundwater samples taken at sites in Connecticut known to be contaminated by heating oil spills (7). Later, this same research group reported finding MTBE contamination to range from 9.7 to 906 mg/L in heating oil and from 74 to 120 mg/L in diesel fuel in samples collected from storage tanks in Connecticut (8). The method used to analyze these samples was based on fuel-water partitioning and GC analysis. This present study provides the detailed basis for that analytical method. MTBE fuel-water partition coefficients as a function of temperature, which are critical to the method, are also presented. This study also reports on variations in MTBE levels as a function of time observed at several residences and a service station. Analytical results are reported for samples taken from terminals as part of an effort to assess the sources of MTBE in heating oil and diesel fuel.

Carcinogens↗
PubMed1993

Using molecular and ecological data to diagnose endangered populations of the puritan tiger beetle Cicindela puritana.

Populations of the puritan tiger beetle Cicindela puritana in the eastern United States were found to be highly threatened at the Connecticut River, whereas several large populations on the western shore and newly discovered populations on the eastern shore of the Chesapeake Bay appeared to be less endangered. We assessed if the disjunct C. puritana subgroups are genetically distinct and therefore should be treated as separate units for conservation purposes. A total of 13 individuals from the Connecticut River and 27 individuals from the Chesapeake Bay were each analysed by sequencing of up to 837 base pairs of mitochondrial DNA per individual. Five different haplotypes could be distinguished. In a phylogenetic analysis of these DNA sequences that included four related Cicindela species as out-groups, haplotypes from the Chesapeake Bay represent a distinct clade. The conservation status of these populations was evaluated using a phylogenetic approach based on cladistic analysis and the framework of the phylogenetic species concept. According to this analysis, beetles from the Connecticut River and the Chesapeake Bay have to be considered as independent units. Populations from the eastern and western shore of Chesapeake Bay are not split in more than one unit using the same criteria, although they exhibited some degree of genetic subdivision. The results from the mtDNA analysis were corroborated by ecological parameters in that the Chesapeake Bay populations can be distinguished from all congeners by their different habitat association.

Animals↗
PubMed1989

Comparative evaluation of three products for the detection of Borrelia burgdorferi antibody in human serum.

Eighty human serum specimens tested concomitantly by immunoblot and an enzyme-linked immunosorbent assay developed jointly at the University of Connecticut School of Medicine and the Connecticut Agricultural Experiment Station were used to evaluate three commercially available diagnostic products for Lyme borreliosis. The sources of the kits were Hillcrest Biologicals, Cypress, Calif.; Whittaker Bioproducts, Walkersville, Md.; and Cambridge Bioscience, Worcester, Mass. When compared with Western blot analysis, the sensitivities and specificities, respectively, for the diagnostic assays were as follows: Hillcrest Biologicals, 93 and 75%; Whittaker Bioproducts, 73 and 100%; Cambridge Bioscience, 89 and 100%; and University of Connecticut School of Medicine, 96 and 92%.

Antibodies, Bacterial↗
PubMed1993

Serologic evidence of canine and equine ehrlichiosis in northeastern United States.

In a retrospective study, indirect fluorescent-antibody staining methods were used to detect immunoglobulins to Ehrlichia canis and Ehrlichia risticii in canine and equine sera that had originally been analyzed for antibodies to Borrelia burgdorferi. Analyses of 60 dog serum specimens collected in Connecticut and New York State during 1986 revealed antibodies to E. canis in 7 (11.7%) specimens; titration endpoints ranged from 1:40 to 1:320. Three of these dogs had anemia. Of the 187 equine serum specimens obtained in Connecticut during 1985 and analyzed by indirect fluorescent-antibody staining methods, 17 (9.1%) contained antibodies to E. risticii. Maximal antibody titers of 1:1,280 were recorded for serum specimens collected from three equids during May and July. We conclude that canine and equine ehrlichiosis coexist with Lyme borreliosis in Connecticut and the lower Hudson River Valley of New York State.

Animals↗
PubMed2001

Partitioned prostate cancer prevalence estimates: an informative measure of the disease burden.

STUDY OBJECTIVES: Public health burden of disease is often measured using prevalence statistics. Prevalence of invasive prostate cancer in the United States is presented according to age at diagnosis, time from diagnosis, geographical area, and two races (white and black). DESIGN: Invasive prostate cancer data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute is used for obtaining prevalence estimates. MAIN RESULTS: Despite falling prostate cancer incidence rates, the prevalence of this disease continues to rise for both white and black men. Black men diagnosed at ages 60 years and older experience lower levels of prevalence of prostate cancer than white men because of poorer survival and a smaller proportion of black men living to older ages where the disease becomes common. Black men require fewer years of follow up than white men to capture over 99% of prevalent cases (that is, 14 years versus 16 years, respectively). Prevalence estimates in the United States are traditionally based on Connecticut data. On 1 January 1997, United States prostate cancer prevalence estimates based on Connecticut are overestimated for white men and underestimated for black men. CONCLUSIONS: Partitioned prevalence estimates may provide a more meaningful and informative measure of the disease burden than conventional prevalence estimates. Prostate cancer prevalence estimates based on SEER rather than Connecticut data are better representative of the United States.

Adolescent↗
PubMed2001

Medicaid's beta 2-agonist recipients and their treatment by national standards.

OBJECTIVE: To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared. RESULTS: Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04). CONCLUSIONS: A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.

Adolescent↗