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At least 1,531 records · Page 85Linked to original sources
PubMed2006

Comorbid diabetes mellitus and risk of death after diagnosis of colorectal cancer: a population-based study.

BACKGROUND: The few studies that have examined the association between comorbid diabetes mellitus (DM) and survival after diagnosis of colorectal cancer have involved small numbers of patients with DM, and cause of death was not examined. METHODS: All 542 African American (black) and 8,853 white Connecticut residents diagnosed with colorectal cancer in 1994-1999 were identified from the population-based statewide Connecticut cancer registry. Comorbid DM was defined as an inpatient hospital admission (prior to or around the time of colorectal cancer diagnosis) that included DM as one of up to 10 discharge diagnoses. RESULTS: Comorbid DM, identified for 1014 (10.8%) of the 9395 patients, was associated with a statistically significantly elevated risk of death from any cause (hazard ratio or HR=1.38, 95% confidence interval 1.27-1.49), in a proportional hazards regression model that included age, sex, race and extent of disease at diagnosis. This finding was due to an elevated risk of death from causes of death other than colorectal cancer. CONCLUSIONS: Studies are needed on quality of care for comorbid DM and its complications among colorectal cancer patients.

Aged↗
PubMed2006

Barriers to condom purchasing: Effects of product positioning on reactions to condoms.

Correct and consistent condom use has been promoted as a method to prevent sexually transmitted infections including HIV. Yet research has repeatedly shown that people fail to use condoms consistently. One influence on the pervasive lack of condom use that has received relatively little attention is the context in which consumers are exposed to condoms (i.e., how condoms are displayed in retail settings). In this paper we present two studies explored variations in condom shelf placement and its effects on people's condom attitudes and acquisition. Study 1 explored the shelf placement of condoms in 59 retail outlets in Connecticut, USA and found that condoms were typically located in areas of high visibility (e.g., next to the pharmacy counter) and on shelves adjacent to feminine hygiene and disease treatment products. In Study 2, 120 heterosexual undergraduate students at the University of Connecticut were randomly assigned to evaluate condoms adjacent to sensual, positive, neutral, or negative products and found that overall men reported more positive attitudes and acquired more condoms when exposed to condoms in a sensual context compared to women in the same condition. Among women, condom attitudes were more positive in the context of neutral products; condom acquisition was strongest for women exposed to condoms in the positive aisles. These results suggest a gender-specific approach to condom promotion. Implications of these studies for HIV prevention, public health, and condom marketing strategies are discussed.

Adolescent↗
PubMed1997

Validation of a clinical prediction rule for left ventricular ejection fraction after myocardial infarction in patients > or = 65 years old.

We sought to validate a previously described clinical prediction rule for classifying left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). As part of the Connecticut cohort of the Cooperative Cardiovascular Project (CCP) pilot study, we identified 3,093 Medicare patients who had been admitted to hospitals throughout Connecticut with an AMI in 1992 and 1993. Retrospective chart review and detailed electrocardiogram interpretation were performed. Of the 1,891 patients with an interpretable EF, 1,378 (73%) had > or = 1 of the rule's exclusion criteria. Of the remaining 513 patients, the clinical prediction rule had a positive predictive value of 89% (i.e., 456 of 513 patients had an EF > or = 40%). In a multivariate model, presentation > 6 hours after the onset of chest pain, a history of bypass surgery, and diabetes mellitus were associated with patients in whom the rule did not correctly predict an EF > or = 40%. Excluding patients with these characteristics from the rule increased the positive predictive value from 89% to 93% and excluded an additional 239 patients. The EF could not be predicted among the patients who did not meet the rule's criteria. In conclusion, a previously published clinical prediction rule for the classification of the EF in patients after an AMI correctly classified 8 of every 9 eligible elderly patients as having an EF > or = 40%. Thus, while not performing as well as it did in the original study, our findings support the use of this rule in providing clinicians with an objective method for estimating an EF > or = 40% in a specific subset of elderly patients.

Aged↗
PubMed2003

Drivers' use of handheld cell phones before and after New York State's cell phone law.

BACKGROUND: In response to public concern about driver distraction from cellular telephones, New York became the first state to ban handheld cell phone use while driving. The law, accompanied by considerable publicity, included a warning phase (November 2001), after which violators could be fined. Until March 2002, fines could be waived if motorists provided proof of purchase of hands-free accessories. METHODS: Daytime cell phone use among passenger vehicle drivers was observed at controlled intersections 1 month before the law's implementation, after fines could be issued (December 2001), and after waivers were not allowed (March 2002). Use was observed for 37,462 vehicles in four New York communities and 21,315 vehicles in two central Connecticut communities. Driver gender, estimated age, and vehicle type were recorded for cell phone users and a sample of passing motorists. RESULTS: The use rate in New York declined significantly from 2.3% before the law to 1.1% after the law (P < 0.05). Use rates in Connecticut, an adjacent state without a law, did not change. In both states, use was higher among drivers of sport utility vehicles (P < 0.05) and minimal among drivers ages 60 or older. In New York, observed use declined among drivers younger than 60, male and female drivers, and all vehicle types. CONCLUSIONS: A well-publicized law restricting drivers' use of handheld cell phones had a strong effect on behavior. Whether compliance will remain high is unknown.

Adult↗
PubMed1994

Monitoring patients taking methotrexate for hepatotoxicity. Does the standard of care match published guidelines?

BACKGROUND: Controversy persists regarding the validity of published guidelines for the monitoring of methotrexate-induced hepatotoxicity. OBJECTIVE: The purpose of our study was to assess the standard of care by gastroenterologists in the monitoring of methotrexate-induced hepatotoxicity and to compare this standard of care with guidelines in the medical literature. METHODS: Gastroenterologists in Connecticut and Massachusetts were surveyed by a mail-in questionnaire that inquired about their protocol for the monitoring of hepatotoxicity in patients taking methotrexate. RESULTS: Gastroenterologists in Connecticut and Massachusetts generally follow the guidelines in the medical literature. Variation in recommendations from the rheumatologic and the dermatologic literature is reflected in the practice habits of gastroenterologists whose patients are restricted to one particular population. CONCLUSION: Long-term follow-up studies should be continued to obtain further data from which to make future recommendations, especially with regard to the effects of large cumulative doses of methotrexate.

Alanine Transaminase↗
PubMed1999

Subject loss in spatial analysis of breast cancer.

Possible selection bias from assignment of latitude-longitude coordinates to the place of residence of all Connecticut women diagnosed with breast cancer from 1992 to 1995 (N = 11,470) was evaluated. Exact address-matching was accomplished for 8,121 records (70.8%) and an additional 1,722 records (15.0%) were matched using relaxed criteria. We did not address-match 1,627 records (14.1%) due to missing address information or limitations of the Geographic Information Systems street file. The age-adjusted likelihood of address-matching records was significantly greater for women of color, those born within Connecticut, residents of urban locales or census tracts with low median family incomes and those cases diagnosed nearer to 1992. Few differences in address-matching were attributable to tumor characteristics or therapeutic modality.

Adult↗
PubMed2000

The development of a post-baccalaureate certificate program in molecular diagnostics.

A post-baccalaureate certificate program in diagnostic molecular sciences was created in 1995 by the Diagnostic Genetic Sciences Program in the School of Allied Health at the University of Connecticut. The required on-campus lecture and laboratory courses include basic laboratory techniques, health care issues, cell biology, immunology, human genetics, research, management, and molecular diagnostic techniques and laboratory in molecular diagnostics. These courses precede a 6-month, full-time practicum at an affiliated full-service molecular laboratory. The practicum includes amplification and blotting methods, a research project, and a choice of specialized electives including DNA sequencing, mutagenesis, in situ hybridization methods, or molecular diagnostic applications in microbiology. Graduates of the program are immediately eligible to sit for the National Credentialing Agency examination in molecular biology to obtain the credential Clinical Laboratory Specialist in Molecular Biology (CLSp(MB). This description of the University of Connecticut program may assist other laboratory science programs in creating similar curricula.

Connecticut↗
PubMed2003

Volatilization of weathered chiral and achiral chlordane residues from soil.

To mitigate the impact on the environment of persistent organic pollutants (POPs), we must understand thoroughly their environmental fate. Residues of many of these pollutants are still present in soil years after their legitimate uses were banned. In this report, the volatilization of one such persistent pollutant, chlordane, from a field where it was applied approximately 40 years ago, is examined in detail overthe course of several years. Ambient air samples were collected at three heights above the treated soil throughout the investigation. Air samples were also collected at several background sites in Connecticut for comparison. Analysis of these samples shows that chlordane volatilization from soil continues to occur long after initial application, at rates dependent on both temperature and cultivation of the soil. Comparison of relative concentrations and enantiomeric profiles for components of technical chlordane in atmospheric samples from a variety of sources suggests a regional, urban input of chlordane to the ambient air over Connecticut, possibly related to the widespread termiticidal use of chlordane in home foundation soils.

Chlordan↗
PubMed2005

Dissolved trace element concentrations in the East River-Long Island Sound system: relative importance of autochthonous versus allochthonous sources.

Dissolved trace metal (Ag, Cd, Cu, Fe, Ni, Pb, and Zn), inorganic nutrient (NO3, NH4, PO4, H4SiO4), and DOC concentrations were measured at 43 stations during low (July 2000) and high (April 2001) river discharge conditions in surface waters of Long Island Sound (LIS). To evaluate the impact of fluvial sources to the total metal budget of the sound, samples were collected from major tributaries discharging into LIS (Thames, Quinnipiac, Housatonic, Connecticut, and East Rivers). To compare LIS with other coastal embayments, samples were also collected from five LIS coastal embayments (Manhassett Bay, Huntington Harbor, Oyster Bay, Hempstead Harbor, and Port Jefferson Harbor), which are monitored by the U.S. National Status and Trends Program. Metal and nutrient distributions identified two biogeochemical regimes within LIS: an area of relatively high nutrient and metal concentrations in the East River/Narrows region in western LIS and an area in the eastern region of the sound that had comparatively lower concentrations. Mass balance estimates indicated that, during low flow conditions, the East River was the dominant allochthonous source of most trace metals (Ag, Cd, Cu, Ni, Zn) and inorganic nutrients (NO3 and PO4); during high flow conditions, the most influential source of these constituents was the Connecticut River. Mass balance estimates also evidenced a large autochthonous source of Cu, Ni, and Zn, as their spatial distributions displayed elevated concentrations away from point sources such as the East River. Principal component analysis suggested that metal and nutrient distributions in the LIS system were influenced by different seasonal processes: remobilization from contaminated sediments, anthropogenic inputs from sewage discharges and phytoplankton scavenging during the spring freshet, and benthic remobilization during summer conditions.

Carbon↗
PubMed2000

Changing patterns of tonsillar squamous cell carcinoma in the United States.

OBJECTIVE: Tonsillar squamous cell carcinoma (SCC) may differ etiologically from other oral cancers. The aim of this study was to provide a detailed description of the incidence patterns of tonsillar SCC in the United States. METHODS: Population-based incidence data from the Connecticut Tumor Registry (period 1945-1994) and from the SEER program (period 1973-1995) were used to calculate age-standardized (US 1970) and age-specific incidence rates and confidence intervals (CIs). Linear regression was used to evaluate trends. RESULTS: The incidence of tonsillar SCC increased fourfold among white women in Connecticut during 1945-1994 but remained rather constant in white men. During 1973-1995, incidence rates per million person-years were considerably higher in blacks (31.6; 95% CI: 29.0-34.4 in men, and 9.6; 95% CI: 8.3-10.9 in women) than whites (14.8; 95% CI: 14.3 15.3 in men, and 6.1; 95% CI: 5.8-6.4 in women). Men, but not women, who were younger than 60 years experienced significant annual increases in tonsillar SCC incidence during 1973-1995 (2.7% in blacks and 1.9% in whites). No similar increases occurred for oral SCC at non-tonsillar sites. CONCLUSION: Incidence rates of tonsillar SCC vary considerably by sex, race and time in a way that cannot be explained by changes in tonsillectomy practices alone. Changes in environmental risk factors, including changes in smoking patterns and an increase in oral human papillomavirus infections, may have contributed.

Adult↗
PubMed2002

Integrated monitoring of a new group B streptococcal disease prevention program and other perinatal infections.

OBJECTIVE: To determine levels of prenatal screening for several infections, intrapartum recognition of risk factors, and prophylaxis against mother-to-child transmission of group B streptococcus. METHODS: Review of stratified random sample of hospital records for deliveries in Connecticut during 1996. SUDAAN analysis was used to adjust for the complex survey design, and weighting adjusted for the probability of being sampled and nonresponse. RESULTS: Of 992 records requested, 868 (88%) were abstracted and analyzed. Thirty-six percent of women had prenatal screening for group B streptococcus and 26% had been tested for human immunodeficiency virus (HIV), while 97-99% of women had been screened prenatally for hepatitis B surface antigen, rubella, and syphilis. Of those women tested, 17% were detected as group B streptococcus carriers, and 78% of these received intrapartum antibiotic prophylaxis. Among women who were not screened for group B streptococcus prenatally, 22% met risk-based criteria for prophylaxis, but only 45% of these received intrapartum prophylaxis. Among unscreened women with a risk factor, those with shorter hospital stays prior to delivery, admitted on evening or night shifts, or who delivered on the weekend were significantly less likely to receive intrapartum prophylaxis. CONCLUSION: In 1996, the majority of women who delivered in Connecticut were not tested prenatally for group B streptococcus and the majority of those not tested in whom there was an indication for prophylaxis were not treated. Compliance with group B streptococcus prevention recommendations can be improved through increased prenatal testing and/or better recognition of risk-based criteria for intrapartum prophylaxis.

Anti-Bacterial Agents↗
PubMed2003

Oral contraceptives and the risk of ductal breast carcinoma in situ.

UNLABELLED: Recent evidence suggests that oral contraceptive use is associated with little to no increased risk of invasive breast carcinoma. No study has examined the relationship between oral contraceptive use and the risk of non-invasive breast carcinoma, that is, breast carcinoma in situ. OBJECTIVE: To define the role of oral contraceptive use in the development of breast carcinoma in situ. METHODS: The data are 875 ductal carcinoma in situ (DCIS) cases diagnosed among residents of the state of Connecticut from September 15, 1994 to March 14, 1998 and between the age of 20 and 79 years as well as 999 control subjects. Controls are female Connecticut residents collected via random-digit-dial and frequency matched to the cases by 5-year age intervals. Telephone interviews were used to collect information on risk factors and cancer screening history. Logistic regression was used to provide maximum likelihood estimates of the odds ratios (OR) with 95% confidence intervals (95% CI). RESULTS: The risk of being diagnosed with DCIS for women who had ever used oral contraceptives was not increased relative to women who had never used them (OR: 1.0, 95% CI: 0.8, 1.2). The risk did not significantly increase with duration of oral contraceptive use, nor with duration of high estrogen use, time since last use, progestin or estrogen type, or age at first use. Furthermore, the association between oral contraceptive use and DCIS risk did not vary by the presence of a family history of breast cancer or by menopausal status. CONCLUSIONS: In these data, no evidence was found for an increased risk of ductal carcinoma in situ associated with the use of oral contraceptives.

Adult↗
PubMed2000

Teaching patient wellness to first-year medical students: the impact on future ability to perform the history of present illness.

OBJECTIVES: Curriculum innovations to improve clinical skills have been implemented at many American medical schools. A current curricular change at the University of Connecticut School of Medicine involves teaching wellness to students in the first year rather than the more traditional focus on disease processes. It is unknown, however, if focusing on wellness detracts from students' future ability to perform the history of present illness (HPI) which requires students to focus on disease processes. DESIGN: The current study examined this issue by comparing two cohorts' clinical skills (n=156), with one class participating in a traditional curriculum during their first year and the other in a revised curriculum teaching wellness during the first year. Each class was evaluated at the beginning of their second year to determine their level of clinical competence. SETTING: University of Connecticut School of Medicine SUBJECTS: Second-year medical students. RESULTS: Analyses suggested that teaching wellness did not detract from future ability to perform an HPI, and in fact students taught wellness had significantly higher history-taking scores. CONCLUSIONS: Curricular innovations which stress wellness and prevention early in medical education do not detract from and may enhance students' ability to perform the history of present illness later during medical training.

Clinical Competence↗
PubMed1985

Prenatal x-ray exposure and childhood cancer in twins.

We conducted a case-control study to investigate the relation between prenatal exposure to x-rays and childhood cancer, including leukemia, in over 32,000 twins born in Connecticut from 1930 to 1969. Twins as opposed to single births were chosen for study to reduce the likelihood of medical selection bias, since twins were often exposed to x-rays to diagnose the twin pregnancy or to determine fetal positioning before delivery and not because of medical conditions that may conceivably pre-dispose to cancer. Each of 31 incident cases of cancer, identified by linking the Connecticut twin and tumor registries, was matched with four twin controls according to sex, year of birth, and race. Records of hospitals, radiologists, and private physicians were searched for histories of x-ray exposure and other potentially important risk factors. Documented prenatal x-ray exposures were found for 39 per cent of the cases (12 of 31) and for 26 per cent of the controls (28 of 109). No other pregnancy, delivery, or maternal conditions were associated with cancer risk except low birth weight: 38 per cent of the cases as compared with 25 per cent of the controls weighed under 2.27 kg at birth. When birth weight was adjusted for, twins in whom leukemia or other childhood cancer developed were twice as likely to have been exposed to x-rays in utero as twins who were free of disease (relative risk, 2.4; 95 per cent confidence interval, 1.0 to 5.9). The results, though based on small numbers, provide further evidence that low-dose prenatal irradiation may increase the risk of childhood cancer.

Adolescent↗
PubMed1996

The prevalence of agitation and brain injury in skilled nursing facilities: a survey.

All skilled nursing facilities (SNF) in the state of Connecticut were surveyed to determine the number of residents with a primary diagnosis of brain injury, the incidence of agitation among these residents, and management strategies utilized for agitation in these residents, including consultation with brain injury specialists. One hundred and sixty-two, or 64%, of the SNF responded to the survey, and reported on 140 individuals with a primary diagnosis of brain injury. These individuals were residing in 39, or 24%, of the 162 facilities. Forty-five percent of these 39 facilities had brain-injured residents who met the definition of agitation presented in the survey. Management of agitation was equally distributed between environmental manipulation, formal behaviour care plans and medications. The availability of specialist consultation was variable and included physiatrists (38%), psychiatrists (67%), neurologists (41%), and psychologists (36%). This survey study defined the prevalence of brain-injured residents in Connecticut's SNF, and examined management strategies for agitation in this patient population.

Behavior Therapy↗
PubMed2006

Vehicles driven by teenagers in their first year of licensure.

OBJECTIVE: to determine access to vehicles, vehicle ownership and its correlates, and types of vehicles driven by teenagers during their first year of licensure. METHODS: About 3,500 Connecticut teenagers and their parents recruited at DMV offices participated in a study aimed at persuading parents to impose and maintain driving restrictions on their sons and daughters. Telephone interviews with teens and parents, which included questions on vehicles driven, were conducted upon licensure and at intervals throughout the year. RESULTS: The majority of both male and female teens owned vehicles immediately upon licensure. Family income and number of vehicles in the family were associated with early ownership. A year later 74% owned vehicles. Small cars, which provide inferior crash protection, were the most popular vehicle; the percent driving small cars increased from 36% to 42% over the year. About 25% were driving SUVs, pickups, or sports cars, which may increase crash risk for young beginners. One year after licensure, only 35% of teens were driving midsize or large passenger cars, the types of vehicles recommended for them, and about one-third of these vehicles were 10 or more years old. Owners were more likely than non-owners to drive older and smaller vehicles, to drive more miles, do more risky driving, and to have more traffic violations and crashes. DISCUSSION: Many teenagers in Connecticut were driving vehicles that rank low in crash protection or may increase crash risk. Attention to the young driver problem has been focused primarily on managing driving risks through graduated licensing systems. More attention needs to be given to the vehicles teens drive, and how decisions about vehicle type and ownership are made. Parents exert control over what vehicles their sons and daughters drive, and may benefit from information on how to make choices that better balance cost, safety, and other factors that go into these decisions.

Accidents, Traffic↗
PubMed2005

Requiring belt use as part of a school parking permit program: does it increase students' belt use?

OBJECTIVE: Teenagers have very high motor vehicle crash rates, and their use of seat belts is generally lower than that of adults. A potential school-based strategy to increase teenagers' belt use is a policy making parking privileges contingent on belt use by student drivers and their passengers. This study evaluated the effects of implementing a school belt policy. METHODS: The effects of a belt policy were evaluated during the 2003-2004 school year at high schools in two states: Connecticut, a state with a primary enforcement belt law and high belt use rates, and Mississippi, a state with a secondary enforcement law and generally low use rates. Both schools enforced the policy, and violations resulted in a graduated set of penalties leading to the potential loss of parking privileges. Baseline and post-policy belt use rates were obtained from observation surveys of student drivers and their teenage passengers coming to and from school. Changes in belt use were examined relative to belt use trends at comparison schools without a belt policy. Implementation of the policies also was monitored. RESULTS: In Mississippi, among students arriving at school in the morning, driver belt use increased from 42% before the policy to 67% about 6 months after; passenger belt use increased from 16% to 61%, although sample sizes were small. These increases were significantly larger than expected, based on belt use trends at the comparison school in Mississippi. In Connecticut, where 86% of drivers and 79% of their passengers already were belted prior to the policy, there was no significant change. Both schools publicized and monitored the belt policy, and most enforcement occurred in the morning as students arrived at school. CONCLUSIONS: Based on a small-scale application of a belt policy at two schools in different states, a school belt policy may have stronger effects in states where belt use is low. Strong penalties and enforcement are essential elements of an effective policy. Adequate resources and commitment are needed for schools to implement and monitor the type of strong policy needed to sustain high belt use rates. Replication of this study in additional schools appears warranted.

Adolescent↗
PubMed2005

Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance.

OBJECTIVE: To determine the mortality, hospital stay, and total hospital charges and cost of hospitalization attributable to candidemia by comparing patients with candidemia with control-patients who have otherwise similar illnesses. Prior studies lack broad patient and hospital representation or cost-related information that accurately reflects current medical practices. DESIGN: Our case-control study included case-patients with candidemia and their cost-related data, ascertained from laboratory-based candidemia surveillance conducted among all residents of Connecticut and Baltimore and Baltimore County, Maryland, during 1998 to 2000. Control-patients were matched on age, hospital type, admission year, discharge diagnoses, and duration of hospitalization prior to candidemia onset. RESULTS: We identified 214 and 529 sets of matched case-patients and control-patients from the two locations, respectively. Mortality attributable to candidemia ranged between 19% and 24%. On multivariable analysis, candidemia was associated with mortality (OR, 5.3 for Connecticut and 8.5 for Baltimore and Baltimore County; P < .05), whereas receiving adequate treatment was protective (OR, 0.5 and 0.4 for the two locations, respectively; P < .05). Candidemia itself did not increase the total hospital charges and cost of hospitalization; when treatment status was accounted for, having received adequate treatment for candidemia significantly increased the total hospital charges and cost of hospitalization ($6,000 to $29,000 and $3,000 to $22,000, respectively) and the length of stay (3 to 13 days). CONCLUSION: Our findings underscore the burden of candidemia, particularly regarding the risk of death, length of hospitalization, and cost associated with treatment.

Adolescent↗