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PubMed2001

Validity of self-reported cancer history: a comparison of health interview data and cancer registry records.

Few studies have addressed the accuracy of self-reported cancer history, although epidemiologic studies routinely use self-reported information as the sole source of exposure or outcome data or as a criterion for exclusion from study participation. In this paper, false-negative reporting of cancer history is examined in a community-based sample by comparing interview data with tumor registry records. Subjects were participants in the 1980 New Haven Epidemiologic Catchment Area study; in 1995, cancer records (from 1935 onward) were obtained by linking the sample to the Connecticut Tumor Registry. Analyses focused on 263 individuals who had at least one tumor reported to the Connecticut Tumor Registry prior to participation in the Epidemiologic Catchment Area study. The overall rate of false-negative reporting was 39.2%. Logistic regression analysis revealed that false-negative reporting was significantly associated with non-White race, older age, increased time since cancer diagnosis, number of previous tumors, and type of cancer treatment received. In addition, false-negative reporting varied widely by cancer site, ranging from 0% for melanoma skin cancer to 83.3% for central nervous system cancers. The false-negative rate for breast cancer was 20.8%, that for colon and prostate cancers was 42.1%, and that for bladder cancer was 61.5%. Implications of these findings for prevalence estimation and future epidemiologic studies are discussed.

Adolescent↗
PubMed1994

Use of arbitrarily primed polymerase chain reaction analysis to type disease and carrier strains of Neisseria meningitidis isolated during a university outbreak.

Disease and carrier isolates of Neisseria meningitidis from two regions of the United States were typed by the arbitrarily primed polymerase chain reaction (PCR), or random amplified polymorphic DNA (RAPD), method. This technique generates strain-specific arrays of amplified DNA fragments using low-stringency PCR with single, arbitrarily chosen primers. Each of 3 disease isolates and 7 of 11 carrier isolates from an outbreak at the University of Connecticut were indistinguishable using each of 4 primers. In contrast, 22 other isolates (the remaining 4 carrier isolates plus 18 disease and carrier isolates from Connecticut, Illinois, and Missouri) were divided into 18 sets using the same 4 primers. This outcome supports the view that disease isolates from an outbreak may reflect sporadic invasive progression by a strain that also frequently causes asymptomatic colonization. Our results show that RAPD tests provide a sensitive and efficient means of distinguishing genetically different meningococcal strains and that they should facilitate clinical, epidemiologic, and population genetic studies of this important pathogen.

Bacterial Typing Techniques↗
PubMed1994

Temporal patterns in colorectal cancer incidence, survival, and mortality from 1950 through 1990.

BACKGROUND: Colorectal cancer mortality rates among U.S. white males remained relatively constant from 1950 through 1984 but declined sharply from 1985 through 1990. Those for U.S. white females decreased consistently from 1950 through 1984, with an acceleration of the decline from 1985 through 1990. PURPOSE: A study was planned to investigate patterns in incidence, survival, and mortality rates over time in order to examine possible reasons for the gender difference in mortality trends and for the decrease in the slope of the mortality trends for both males and females in the late 1980s. METHODS: Incidence and survival data from the Connecticut Cancer Registry were examined to investigate the gender differences in mortality rates from 1950 through 1984. Incidence and survival data from the Surveillance, Epidemiology, and End Results (SEER) Program were investigated to examine reasons for the abrupt downturn in mortality rates for both white males and white females beginning around 1985. RESULTS: During the period 1950 through 1984, the colorectal cancer incidence rates in Connecticut increased for males and declined slightly for females. Survival rates were similar for both sexes, increasing on average over 1% per year for both females and males from 1950 through 1984. Examination of SEER data from 1975 through 1990 revealed that for both males and females there were 1) declines in overall incidence and mortality rates beginning in the mid-1980s, 2) steady declines in distant disease incidence rates since 1975, 3) increases in regional disease incidence rates until the early 1980s followed by declines in the late 1980s, and 4) increases in local disease incidence rates until the mid-1980s followed by declines in the late 1980s. Age-period-cohort analyses of mortality rates indicated a statistically significant moderation of colorectal cancer risk with both advancing birth cohorts and recent calendar periods. CONCLUSIONS: The gender differences in colorectal cancer mortality rate trends observed from 1950 through 1984 are due to differences in incidence rate trends between males and females. Declining colorectal mortality rates in the late 1980s for males and females appear to reflect improved early detection. The peaking and subsequent decline of stage-specific incidence rates at later years for successively lower stage indicate sequential stage shifts as cancers are detected increasingly earlier over time. The increased use of sigmoidoscopy and fecal occult blood tests (triggering colonoscopy) appears to have played an important role in reducing colorectal cancer mortality. Improvements in birth cohort trends in risk for colorectal cancer for each sex suggest that lifestyle changes may have also contributed to the steady reductions in colorectal cancer mortality.

Adult↗
PubMed1978

Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector.

Forty-three residents of 12 contiguous Connecticut communities were identified who had the onset of erythema chronicum migrans, Lyme arthritis, or both during the summer and fall of 1977. Nine of them (21%) remembered having been bitten by a tick at the site of the initial skin lesion a median of 12 days (range 3-20) before onset; one patient brought in the tick for identification (Ixodes scapularis). Compared to 64 of their neighbors, significantly more patients had cats and farm animals, and had noted ticks on their pets and tick bites on themselves. The incidence of the illness during 1977 was 2.8 cases per 1000 residents in the three communities on the east side of the Connecticut River, compared to 0.1 cases per 1000 residents in the nine communities on the west side, a difference of almost 30-fold. Taken with the results of a concomitant acarological study on both sides of the river, these findings support the hypothesis that erythema chronicum migrans and Lyme arthritis are tick-transmitted, specifically by I. scapularis.

Adolescent↗
PubMed1980

Maternal and antenatal factors in the risk of sudden infant death syndrome.

The prenatal course, labor and delivery of 90 mothers of infants who died of Sudden Infant Death Syndrome (SIDS) in Connecticut from 1974 through 1976 were studied by hospital chart reviews. Charts of 90 pair-matched controls whose infants survived the first year of life were also examined. Significant associations were found between SIDS and: 1) maternal age under 20 years, 2) later initial prenatal visit, 3) maternal blood type O, 4) reported conditions during the pregnancy. The racial distribution of the infants of the study population differed significantly from the distribution of births in Connecticut during these years, with a higher than expected proportion of blacks among the case infants. Male infants in the study population outnumbered females three to two, and cases weighed an average of 430 grams less than controls at birth.

Adolescent↗
PubMed1986

Blood pressure concordance between spouses.

In 1982, 4,474 noninstitutionalized residents of Connecticut who were 18 years or older were interviewed as part of the Connecticut High Blood Pressure Program. This cross-sectional study was undertaken to determine the prevalence of hypertension among the 2.1 million adults in the state. Spouse correlations for systolic and diastolic blood pressures were examined in 1,260 white spouse pairs. Upon demonstrating a significant correlation in blood pressure between spouses (r = 0.262 for systolic and 0.248 for diastolic, p less than 0.001), subsequent stepwise multiple regressions were used to determine which aspects of the shared marital environment might influence the spouse concordance. Variables related to each spouse as well as variables reflecting similarity between spouses were analyzed. When spouse concordance in blood pressure was examined controlling for age, obesity, dietary salt intake, socioeconomic status, income, education, occupation, smoking, and exercise of both spouses and similarities in these variables, the correlations between spouses' blood pressures remained significant.

Adolescent↗
PubMed1988

Fibroadenoma and the use of exogenous hormones. A case-control study.

The association between fibroadenoma and the use of exogenous hormones in women aged 18-74 years was examined in a case-control study conducted in Connecticut during 1979-1981. The study population included 251 women with biopsy-confirmed fibroadenoma and 1,081 control women drawn from inpatient and outpatient general surgical services of five Connecticut hospitals. Among women under age 45 years, oral contraceptive use was negatively associated with the occurrence of fibroadenoma (age-adjusted odds ratio (OR) = 0.57, 95% confidence interval (CI) = 0.42-0.79). The odds ratio for women over age 45 years who had ever used oral contraceptives was 1.65 (95% CI = 0.58-4.68). Women over age 45 years who had ever used replacement estrogens had an elevated odds ratio for fibroadenoma (OR = 2.83, 95% CI = 1.21-6.60). The data suggest either that the effects of exogenous hormones may differ by age, or that the changing composition of exogenous hormones has brought about different associations depending upon the cohort of women.

Adenofibroma↗
PubMed1988

Risk of contralateral breast cancer: associations with factors related to initial breast cancer.

A case-control study was conducted to assess the risk factors associated with the development of a contralateral primary breast cancer among women who had had a first primary breast cancer. Hospital records were reviewed for 292 women who had an incident contralateral breast cancer, diagnosed in one of eight Connecticut hospitals between July 1, 1975 and December 31, 1983, and for a comparison group of 264 surviving unilateral breast cancer patients previously diagnosed in the same hospitals. All subjects were identified through the records of the Connecticut Tumor Registry. A family history of breast cancer in any first- or second-degree relative was associated with an almost threefold increased risk of developing a contralateral cancer (adjusted odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.6-4.9). Further, this relation was modified by the time elapsed since the initial cancer diagnosis (ratio of OR = 1.9, 95% CI = 1.2-3.0 for a five-year differential in time since initial diagnosis). A delay of 10 years in first full-term pregnancy was associated with a 36% decrease in risk (adjusted OR = 0.6, 95% CI = 0.3-1.2); this estimate excluded the magnitude of increased risk usually observed in studies of initial breast cancer. A conceptual framework is presented for assessing the study findings in the context of previous studies that have examined the corresponding associations for initial primary breast cancers.

Adult↗
PubMed2000

Syringe laws and pharmacy regulations are structural constraints on HIV prevention in the US.

OBJECTIVE: To review the legal and regulatory barriers that restrict pharmacy sales of syringes to injection drug users (IDUs) and to discuss how reducing these barriers can facilitate access to sterile syringes for IDUs and improve HIV prevention. BACKGROUND: IDUs' access to sterile syringes from community pharmacies in the United States is limited by state laws and regulations governing syringe sales. Restricted availability of sterile syringes from pharmacies is a structural barrier that greatly impedes HIV prevention for IDUs, who often share and reuse syringes because they cannot obtain and possess sterile syringes. These high-risk behaviors contribute to the transmission of HIV and other blood-borne pathogens among IDUs, their sexual partners, and their children. STATE EXPERIENCES: In Connecticut, because of high HIV prevalence among IDUs, restrictive syringe laws were changed. After the legal changes in Connecticut, both pharmacy sales of syringes in areas of high drug use and purchases of syringes in pharmacies (reported by IDUs) increased, while syringe sharing (reported by IDUs) decreased. Maine and Minnesota have made similar changes in laws. CONCLUSIONS: Increasing access to sterile syringes through pharmacies requires the repeal or modification of legal barriers. Pharmacy sale of syringes to IDUs is an inexpensive HIV prevention intervention with the potential to substantially reduce HIV transmission. Further studies are needed to document how changes to legal barriers can influence HIV prevention for IDUs.

Connecticut↗
PubMedDate not supplied

Meeting the educational needs of clinical equipment users.

Training equipment users to operate medical equipment effectively and safely is one of the most important and difficult tasks of clinical engineers. As medical equipment proliferates and becomes more complex, the task of education also becomes more difficult. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires that all equipment users be trained annually in proper operating procedures for the equipment they use and that the training be documented. Therefore, each hospital must develop educational programs to meet those needs. This paper illustrates the use of an interactive computer-assisted instruction (CAI) program, entitled EquipTeach, to provide an effective, standardized and cost-effective method of training equipment users at the John Dempsey Hospital of The University of Connecticut Health Center in Farmington, Connecticut.

Computer-Assisted Instruction↗
PubMed1975

State response to federal policy: children, EPSDT, and the Medicaid Muddle.

The implementation in Connecticut of Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a program of comprehensive medical care for needy children, illustrates the complexities engendered by federally mandated state-administered health programs. The EPSDT amendments to Title V and Title XIX (Medicaid) were ambiguous on four major issues: administrative responsibility, costs, eligibility, and scope of services. The problems experienced by federal, regional, state, and local administrators in resolving these issues illustrate the weaknesses inherent in federal-state relations, and the contrasting roles health and welfare agencies under Medicaid have played in the development of health policy. Connecticut may represent maximum limits to state performance in carrying out EPSDT because it is a rich state, ranking high in medical resources and in the provision of Medicaid services. During the first year of implementation of EPSDT, the program had little impact: less than 5 percent of eligible children were served. State policies, which contravened federal policy, precluded effective resolution of the legislative ambiguities; no new services were added, the organization of health services remained unchanged and fragmented; and the State Health Department played only a limited role.

Child Health Services↗
PubMed2001

How frequent is postmastectomy breast reconstructive surgery? A study linking two statewide databases.

Studies of the frequency of reconstructive surgery among breast cancer patients have involved non-population-based sources, incomplete ascertainment, or both. Postmastectomy breast reconstructive surgery among 4688 breast cancer patients (diagnosed between 1992 and 1996) was estimated by linking a population-based cancer registry with a statewide hospital discharge database in Connecticut. Of these 4688 patients, 585 (12.5 percent) had reconstruction coded in one database or both databases. The reconstruction rates were higher than in a previous study in Connecticut and increased from 9 percent in 1992 to 16 percent in 1996. Reconstruction was not related to the patient's tumor size, marital status, or race (black versus white), but declined with increasing age at diagnosis and with poverty rate (of the census tract of residence). These associations were similar to those reported from previous studies.

Aged↗
PubMed1980

Malignant melanoma associated with breast cancer.

The experience of the population-based Connecticut Tumor Registry was analyzed for the occurrence in the same patient of breast cancer and malignant melanoma. A total of 18,010 women with breast cancer were followed up for the subsequent development of malignant melanoma of the skin or eye. Similarly, 835 women with cutaneous or ocular malignant melanoma were followed up for the subsequent development of breast carcinoma. Survival experience for these cohorts and appropriate Connecticut Tumor Registry incidence rates were used to calculate an expected number of individuals with both types of malignant neoplasms. Twenty-three women had both types of tumors diagnosed at least one month apart. Fewer than 14 such occurrences were expected (P < .05). The two tumors may be related through hormonal factors, particularly when considered with regard to the findings of other laboratory and epidemiologic studies.

Adult↗
PubMed1996

Marital status in relation to Kaposi's sarcoma, non-Hodgkin's lymphoma, and anal cancer in the pre-AIDS era.

Persons with human immunodeficiency virus/AIDS are at high risk of Kaposi's sarcoma (KS), non-Hodgkin lymphoma (NHL), and possibly anal cancers. To examine whether this risk preceded the AIDS epidemic, we used pre-AIDS era data from the Surveillance, Epidemiology, and End Results program (excluding Connecticut) from 1973 to 1976, and the Connecticut Tumor Registry from 1940 to 1976. We compared risk of being single (a surrogate to identify men who might be homosexual) to those ever married, using a case control matching study with up to 10 controls per case. Overall, no excess risk was observed for KS (risk ratio for men 20-59 years old: 1.00; 95% confidence interval 0.218-3.61), but there was a suggestion of higher risk (4.00; 0.54-29.48) in 1973-1976, the period just before the AIDS epidemic. The NHL risk (0.85; 0.74-0.99) was slightly low, but for anal cancer the risk ratio of being single was significantly high both in men 20-59 years old (5.68) and older men (2.78) long before the AIDS epidemic. If the excess risk was solely due to being homosexual, the actual relative risk in the subset who were homosexual must have been much higher, given that only a fraction of the single men would have been homosexual. As comparison groups to verify the methodology, we used colon (no association with marital status) and prostatic cancer (decreased in single men), with findings as reported in other studies. Thus, single men may have been at an excess risk of KS (but a slightly low risk of NHL) just before the AIDS epidemic and have been at excess risk of anal cancer for many years before the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Active tuberculosis in HIV-infected injecting drug users from a low-rate tuberculosis area.

This article describes the features of active tuberculosis in HIV-infected injecting drug users (IDUs) from a low-rate tuberculosis area. The cohort was followed in a hospital-based HIV/AIDS registry, and data were extracted from the registry, patient charts, and the Tuberculosis Control Program of the Connecticut Health Department. The setting was an acute care inner-city hospital-based health care system, with a high incidence of AIDS, serving a small-to-medium urban area in Connecticut. The patients were 905 HIV-infected IDUs whose time of HIV diagnosis (TOHD) was between 1984 and 1992. The outcome measures were demographics, clinical characteristics, and morbidity rates of active tuberculosis. Of the 27 IDUs who developed active tuberculosis, none were white, all but one were male, and only one was known to have had a positive purified protein derivative (PPD) reaction prior to TOHD: 59% of cases developed in patients known to be HIV infected, 11% occurred in established AIDS patients, and 67% qualified as extrapulmonary tuberculosis (that is, AIDS defining by pre-1993 definitions). In 22% of cases, both Mycobacterium tuberculosis and M. avium-intracellulare were isolated. Mycobacterium tuberculosis was most commonly isolated from a respiratory specimen (67%). The annual incidence rate has been < or = 1.0% since 1988. The cumulative incidence rate was highest for patients with a positive PPD reaction or a history of tuberculosis (1.4 cases/100 patient years; 52 patients; mean follow-up 4.0 years). The demographics and clinical characteristics of active tuberculosis in our HIV-infected IDUs are similar to those described elsewhere in the United States; the morbidity rates are low and stable. The implications of our findings on tuberculosis control in HIV-infected IDUs may be applicable to health care systems with low tuberculosis rates.

Antitubercular Agents↗
PubMed1983

Mortality and cancer incidence experience of employees in a nuclear fuels fabrication plant.

The mortality and cancer incidence experience of 4,106 employees in a nuclear fuels fabrication plant was evaluated in this retrospective cohort study. Standardized mortality (SMR) and incidence ratios were calculated for groups of employees holding different jobs in the company associated with various types of industrial exposures and with low levels of radiation. Connecticut population mortality rates and Connecticut Tumor Registry incidence rates, specific for age-sex, calendar year and cause of death or cancer site, were used for the calculation of expected rates. Results showed the SMR for all male employees to be significantly lower than expected for all causes and what would be expected for all cancer deaths. More deaths were observed than expected from diseases of the central and peripheral nervous system and from obstructive pulmonary disease. The overall cancer incidence experience of the male employees was significantly lower than expected; cancer of the brain was found to be significantly higher than expected among the industrial employees. These was no risk associated with any particular job exposure group. Log linear models analysis showed no significant effect from industrial and radiation exposures or from their combined influence.

Adult↗
PubMedDate not supplied

Trends in the use of second trimester maternal serum screening from 1991 to 2003.

PURPOSE: To identify trends in the utilization of second trimester maternal serum screening, follow-up amniocenteses, and the detection of Down syndrome-affected pregnancies between 1991 and 2003. METHODS: We reviewed all triple and quadruple maternal serum screening tests referred to the University of Connecticut screening laboratory from women with singleton pregnancies. For each calendar year, the total number of tests, proportion to women aged 35 or older, number of follow-up amniocenteses, and the number of prenatally and postnatally diagnosed Down syndrome cases were recorded. RESULTS: A total of 109,469 women received screening. In 1991, the proportion of older women who received screening was 58% of that present in the Connecticut population but by 2003 this had increased to 83% (P < 0.001). In Down syndrome screen-positive pregnancies, there was no significant change in the rate of amniocentesis utilization (average 73%), but in false-positives, there was a decline from 70% in 1991 to 27% in 2003 (P < 0.001). CONCLUSION: Increased use of maternal serum screening by older women, use of second trimester ultrasound, and improvements in screening methodology have resulted in sharply reduced numbers of amniocenteses in unaffected pregnancies.

Biomarkers↗
PubMedDate not supplied

Essential concepts in developing community-university partnerships. CareLink: the Partners in Caring Model.

University and community partnerships are being created to increase community-based educational experiences for nursing students and to assist agencies in facing ever-decreasing resources to pay for health services for clients. Many challenges often burden these partnerships, leading to a less than satisfying experience for all those involved. The Partners in Caring Model described in this article is one approach to forming a successful partnership, proven effective in meeting the educational needs of the University of Connecticut, School of Nursing students, while providing additional resources to the Visiting Nurse Association of Central Connecticut, Inc. Using Anderson and McFarlane's Community as Partner Model as the framework, the essential principles behind the development of this successful partnership are discussed. The Partners in Caring Model demonstrates that community-university partnerships can sustain themselves when the partners have a commitment to care for the population being served, and it is a shared responsibility between education and practice.

Community Networks↗