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At least 1,585 records · Page 88Linked to original sources
PubMed2001

Early-onset neonatal sepsis in the era of group B streptococcal prevention.

OBJECTIVE: To determine whether intrapartum antibiotic prophylaxis for neonatal group B streptococcal (GBS) disease has resulted in an increased rate of non-GBS or antibiotic-resistant early-onset invasive neonatal disease. METHODS: Maternal and infant chart review of all infants with bacteria other than GBS isolated from blood or spinal fluid in 1996 through 1999 in 19 hospitals (representing 81% of in-state births to state residents) throughout Connecticut. Suspected cases were identified through clinical microbiology laboratory records or through International Classification of Diseases, Ninth Revision codes when microbiology records were incomplete. RESULTS: Ninety-four cases of non-GBS early-onset sepsis or meningitis were detected between 1996 and 1999. The rate of GBS-related early-onset infection (days 0-6 of life) dropped from 0.61/1000 to 0.23/1000 births, but the annual rate of non-GBS sepsis remained steady, ranging from 0.65 to 0.68/1000 during the surveillance period. There was an increase in the proportion of Escherichia coli infections that were ampicillin resistant between 1996 and 1998, but the proportion decreased. in 1999 CONCLUSION: There was no increase in the incidence of non-GBS early-onset neonatal infections between 1996 and 1999. Fluctuations in the annual incidence of E coli infections, including ampicillin-resistant infections, suggest the need for continuation of surveillance in Connecticut and expansion to monitor larger populations.

Antibiotic Prophylaxis↗
PubMed2004

Supplemental diagnosis of Kudoa funduli (Myxozoa) parasitizing Fundulus heteroclitus (Cyprinodontidae) from coastal northeastern North America.

The diagnosis of Kudoa funduli (Hahn, 1915) Meglitsch, 1948 (Myxozoa), is supplemented through study of new material collected from Fundulus heteroclitus (Cyprinodontidae) in coastal waters of Nova Scotia, Canada, and Connecticut. Plasmodia normally develop intracellularly in striated muscle of the flank and head, eventually rupturing and releasing spores. Spores disperse along adjacent epimysium, sometimes as far as the skin surface. Some plasmodia develop extracellularly within the bony cavities of vertebrae. Formalin-fixed spores viewed with a light microscope possess rounded edges, an inconspicuous apical region, thin sutural ridges, measure 6.6-7.4 microm wide, 4.3-5 microm thick, and 5.1-5.4 microm long, and have 4 equally sized polar capsules, 1.7-2.3 microm length by 1.4-1.7 microm width. Scanning electron microscopy revealed that spores are almost stellate, with inconspicuous uplifted tips, and that, within intracellular plasmodia, are embedded in an extensive honeycomb-like matrix. Prevalence of infection of K. funduli was 100% in host populations sampled in both Nova Scotia and Connecticut. Molecular sequence data of the 18S ribosomal DNA (737 base pairs) reveal that K. funduli is a valid species and a member of a clade that includes Kudoa dianae Dyková, Avila, and Fiala, 2002, Kudoa miniauriculata Whitaker, Kent, and Sakanari, 1996, and Kudoa paniformis Kabata and Whitaker, 1981.

Animals↗
PubMed1989

Late-stage diagnosis of breast cancer in women of lower socioeconomic status: public health implications.

To assess the success of breast cancer control activities in Connecticut, we examined data from the Connecticut Tumor Registry, determining differences in breast cancer stage at time of diagnosis over time and in selected subgroups. From 1982 to 1985, the percentage of women with cancer confined to the breast increased from 54.0 percent to 61.3 percent. During 1984 and 1985, lower socioeconomic status (SES) women with breast cancer were less likely than higher SES women to be diagnosed with early-stage disease (56.9 percent vs 62.7 percent). SES was estimated by census tract of residence. In the same years, the overall incidence of breast cancer was greater in higher SES women. Projections based on these incidence data found that lower SES women, as compared to higher SES women, had a higher rate of expected breast cancer deaths (24.6 vs 19.7 per 100,000), and a greater percentage of those deaths considered preventable by early detection (22 percent vs 11 percent). The rate of preventable deaths in lower SES women was 2.5 times as great as that for higher SES women (5.3 vs 2.1 per 100,000). Tumor registries can serve as useful surveillance systems to aid cancer control programs. Breast cancer early-detection programs should give special attention to lower SES women.

Black or African American↗
PubMed1999

Weight loss counseling by health care providers.

OBJECTIVES: This study explores the pattern of weight loss counseling by health care providers in Connecticut and the associated weight loss efforts by patients. METHODS: Data from the 1994 Connecticut Behavioral Risk Factor Surveillance System survey were analyzed to determine (1) the frequency of weight management counseling by health care providers of overweight adults with and without additional cardiovascular risk factors and (2) the current weight loss practices of overweight subjects. RESULTS: Only 29% of all overweight respondents and fewer than half with additional cardiovascular risk factors, reported that they had been counseled to lose weight. CONCLUSIONS: The findings suggest a need for more counseling of overweight persons, especially those with cardiovascular disease risk factors.

Adolescent↗
PubMed2000

Prevalence of high-risk food consumption and food-handling practices among adults: a multistate survey, 1996 to 1997. The Foodnet Working Group.

Risk factors for foodborne diseases include consumption of high-risk foods and unsanitary food-handling practices; however, little is known about the prevalence of these risk factors in the general population. A survey was done in five FoodNet sites (California, Connecticut, Georgia, Minnesota, Oregon) to determine the prevalence of these risk factors in the population. A total of 7,493 adults were interviewed by telephone between 1 July 1996 and 30 June 1997. Results showed that 1.5% drank raw milk, 1.9% ate raw shellfish, 18% ate runny egg, 30% preferred pink hamburger, 93% said they almost always washed their cutting board after cutting raw chicken, and 93% said they almost always washed their hands after handling raw meat or poultry, during 5 days before interview. The results differed by state and demographic group. Consumption of raw shellfish (3.2%) and undercooked hamburger (43%) were more common in Connecticut than other states. Raw milk consumption was more common among people who lived on a farm (8.6%) compared with people who lived in a city or urban area (1.1%). Preference for undercooked hamburger was more common among men (35%), young adults (18 to 25 years, 33%), people with college education (38%), and among people with household income of more than $100,000/year (49%). African-Americans were less likely to prefer undercooked hamburger compared to other racial groups (10% versus 30%). Young adults compared to older adults were less likely to wash their hands after handling raw chicken (88% versus 95%), and men washed their hands less often than women (89% versus 97%). Although there were statistical differences between demographic groups, they are insufficient to warrant targeted educational programs.

Adult↗
PubMed1984

Payment of occupational therapy by legislative mandate.

This article reviews the process that the Council on Government Affairs of the Connecticut Occupational Therapy Association undertook from 1979 to 1982 to obtain payment mandated by legislation for occupational therapy. The process included learning the Connecticut legislative system, marketing occupational therapy as a profession in the health arena, and coordinating, planning, and communicating all phases of activity to reach a final objective of mandated payment.

Connecticut↗
PubMed1997

Antibodies to multiple tick-borne pathogens of babesiosis, ehrlichiosis, and Lyme borreliosis in white-footed mice.

Serum samples from Peromyscus leucopus (white-footed mouse), collected in Connecticut (USA) in 1983, 1985, and during 1990 to 1993, were analyzed by an enzyme-linked immunosorbent assay (ELISA) or indirect fluorescent antibody (IFA) staining methods for antibodies to Borrelia burgdorferi (strain 2591), Babesia microti, Ehrlichia chaffeensis (Arkansas strain), and Ehrlichia equi (MRK strain). Of the 294 serum samples tested, 160 (54%) contained immunoglobulins to one or more of these pathogens. There were antibodies to two or more etiologic agents in 77 (48%) of the seropositive mice. Although it was uncommon to detect coexisting antibodies to all four pathogens (n = 5 positive mice), E. chaffeensis-reactive antibodies or immunoglobulins to E. equi were present along with those produced to B. burgdorferi and B. microti in 24 other mice. These rodents carry antibodies to several tick-borne pathogens at numerous sites in Connecticut and may play a role in the epizootiology of ehrlichiosis as well as babesiosis and Lyme borreliosis.

Animals↗
PubMed1998

Patient education as medical intervention: a pilot study.

OBJECTIVE: To describe and assess the perceived impact of an innovative patient health informatics tool among members of a managed care organization. SETTING: Mixed-model HMO in Connecticut. DESIGN: Intervention group only, post-test only (telephone interview using structured protocol). PARTICIPANTS: Members of a Connecticut HMO who responded to a free video offer and met study eligibility requirements. INTERVENTION: Patient education videos from the entire Time Life Medical At Time of Diagnosis series. MAIN OUTCOME MEASURES: Knowledge of condition and treatment options, attitude and outlook towards condition, patient-provider communication, behavior change, physician contacts for condition. RESULTS: Study participants reported that the video improved their understanding and knowledge of treatment options for their condition. They also reported a positive impact of the videos on a range of attitudes and behaviors pertinent to their condition. Participants endorsed the involvement of their HMO in distributing the videos, and few adverse effects from use of the videos were observed. CONCLUSIONS: This study provides preliminary evidence for a positive impact of health informatics tools on patient attitudes, including expectancies for care, quality of patient-physician communication, and satisfaction with health plan. The fact that most persons responding to the video offer had their condition for several years suggests that distribution of health informatics tools should not be limited to the newly-diagnosed.

Chronic Disease↗
PubMed1998

Physicians' perceptions of managed care.

We wished to determine physicians' views and knowledge of managed care, particularly their beliefs about the provisions of managed care contracts in terms of legality and ethics. A questionnaire was sent to the 315 physicians of the medical staff of Norwalk Hospital in Connecticut regarding managed care and managed care contracts. Sixty-six responses were received within a 45-day period (20.9% return). Although only 1 of 11 contract provisions presented in one section of the questionnaire was illegal in Connecticut, a majority of physicians believed 7 of the 11 were illegal. On average, 50% of physicians polled thought each of the provisions was illegal, and a varying majority of physicians (53% to 95.4%) felt the various provisions were unethical. The majority of respondents (84.8% to 92.4%) believed that nondisclosure provisions were unethical. Ninety-seven percent thought managed care interferes with quality of care, and 72.7% of physicians felt that the managed care industry should be held legally responsible for ensuring quality of care. However, 92.4% of physicians considered themselves to be ethically responsible for ensuring quality of care. Physicians have a poor understanding of the legal aspects of managed care contracts but feel strongly that many provisions of these contracts are unethical. Physicians also believe that managed care is causing medicine to be practiced in a manner that is contrary to patients' interests and that legal recourse is needed to prevent this.

Attitude of Health Personnel↗
PubMed1986

Downsizing: the Griffin Hospital experience.

Author John Naisbitt, in Megatrends, referred to Connecticut as a bellwether state. The Griffin Hospital in Derby, Connecticut, has found itself in that position. While other administrators were talking of predictions of declining average daily census and length of stay, Griffin was experiencing these declines. And, while others were beginning the inevitable process toward downsizing, Griffin was already addressing the problem. This article details Griffin's successful downsizing effort and its plans to continue to cope with the factors that led to the original decision to downsize.

Connecticut↗
PubMed1986

Case-mix reimbursement for nursing home services: simulation approach.

Nursing home reimbursement based on case mix is a matter of growing interest. Several States either use or are considering this reimbursement method. In this article, we present a method for evaluating key outcomes of such a change for Connecticut nursing homes. A simulation model is used to replicate payments under the case-mix systems used in Maryland, Ohio, and West Virginia. The findings indicate that, compared with the system presently used in Connecticut, these systems would better relate dollar payments to measure patient need, and for-profit homes would benefit relative to nonprofit homes. The Ohio methodology would impose the most additional costs, the West Virginia system would actually be somewhat less expensive in terms of direct patient care payments.

Computer Simulation↗
PubMed1999

A surplus of physicians? The view of internists at a single institution.

BACKGROUND: The sizable increase in the United States physician workforce over the last 25 years has led to a concern by health policy analysts that we are training too few generalist physicians, too many specialists and too many doctors altogether. Nearly all analysts' studies report that the United States currently has an adequate or more than adequate supply of physicians; however, few reports discuss practicing physicians' view of the issues. OBJECTIVE: To determine internists' opinion regarding the current and future physician supply and specialty mix. DESIGN: Analysis of results of a mailed questionnaire. SETTING: Nine hundred bed academic medical center in southern Connecticut. PARTICIPANTS: Three hundred seventy eight internal medicine attendings, fellows and residents. MEASURES: Seventeen questions that covered 4 domains: is there or will there be a surplus of general internists, internal medicine subspecialists or total physicians in Connecticut or the United States; which internal medicine subspecialties have a current surplus; what is the correct primary care/specialty care mix for our physician workforce; and what subspecialties are current internal medicine residents planning to pursue? RESULTS: A total of 378 of 686 (55%) mailed surveys were returned. The majority of physicians reported that there is currently no surplus of physicians (68%) or general internists (90%) in the Unites States, but that there is a surplus of internal medicine subspecialists (68%). The majority of the physicians who responded that there is no current surplus reported that there would not be a surplus in 10 years. Subspecialties most frequently indicated to have a surplus in the United States were cardiology (70%) and gastroenterology (57%). A majority of internal medicine residents (66%) indicated that they planned to pursue subspecialty fellowship; the fellowship most commonly indicated was cardiology (23%). CONCLUSIONS: In contrast to the opinion of most health policy analysts, the majority of internists associated with our institution do not believe that there is or will be a physician surplus in the United States. Reasons for a difference of opinion between practicing internists and health policy analysts are worthy of further study.

Attitude of Health Personnel↗
PubMed2002

The effects of motorcycle helmet use between hospitals in states with and without a mandatory helmet law.

BACKGROUND: Motorcycle injuries and mortality are different depending on the use of a helmet. Helmet use varies greatly depending on state laws. METHODS: Retrospective study using trauma registry data from two Level 1 Trauma Centers in states with (NY) and without (CT) a mandatory helmet law, from 1996 through 1998. RESULTS: Motorcycle accident victims in both states were similar for sex, age, RTS, TRISS probability of survival, GCS on arrival and ISS. Helmet use was higher in New York than in Connecticut (91% vs 18%, P < .01). Mortality was higher in Connecticut than in New York (15% vs 6%, P < .05). CONCLUSION: The demographics and injury severity of motorcycle accident victims presenting to Level 1 Trama Centers were very similar in the two adjoining states. The most significant difference between the states is that of helmet use. This is closely related to the decreased mortality rate and the higher GCS at discharge seen in the state with the mandatory helmet law.

Accidents, Traffic↗
PubMed1992

A case management agency and bank create a service innovation.

Connecticut Community Care, Inc. (CCCI), a statewide, nonprofit case management agency, in collaboration with Connecticut National Bank (CNB), developed a unique model of delivering case management services to bank trust clients. No reports of such a collaborative model have been found in the published literature in the United States. The article presents a historical overview of this innovative initiative; the identification of the target population; the delivery of the assessment, coordination, and monitoring services; and the marketing techniques. Utilization statistics, a synopsis of the model outcomes as viewed by the trust officers, and suggestions for replication are also presented.

Aged↗
PubMed2005

Defining the impact of high patient/staff ratios on dialysis social workers.

In the beginning of 2003, the renal provider in Connecticut with the largest market share systematically reduced the hours of social workers and dietitians throughout its units. This change was part of a larger strategy of "leveraging and maximizing... organizational and management structure to improve patient, employee, and business care, including increased management emphasis on improving return on invested capital." For social workers in this company, the target ratio appeared to be 160 patients per 1 full-time equivalent. Soon after this increase in case ratio, the Connecticut Council of Nephrology Social Workers (CT CNSW) became concerned about the reduced level of social work services available to patients.

Ambulatory Care↗
PubMed1992

Epidemiologic evidence for the role of indoor tobacco smoke as an initiator of human breast carcinogenesis.

Earlier research suggested an appreciable latent period between the time of exposure to indoor tobacco smoke and the detection of breast cancer. A close relationship was found in the U.S. between state breast cancer mortality from 1978 through 1981 and state cigarette sales from 1950 through 1954 (R = 0.64, p less than 0.001). The correlation declined for sales in subsequent years but remained highly significant until 1970, but not thereafter. Thus, it appears that the role of indoor tobacco smoke in breast carcinogenesis is that of an initiator and/or an early-stage promoter in the process that leads after 15 to 30+ years to cancer. Trends in cigarette consumption from 1915 to 1965 paralleled breast cancer incidence in Connecticut women from 1935 to 1989. The 1953 and 1975 peaks in incidence were related to 1930 and 1953 peaks in cigarette consumption, respectively, showing a 22.5-year latent period. The drop in cigarette sales in the mid-1950s was followed by a surge to new highs in sales in the early 1960s in the great majority of the states. Approximately 23 years later, breast cancer incidence rates in the mid-1980s in all nine SEER populations are reflecting that surge in cigarette sales, rising to an all-time high in 1985. The earliest declines in breast cancer incidence should occur in New York and Connecticut, where cigarette sales have fallen most dramatically. By the year 2015, white women in the South, currently living with the men with the highest lung cancer rates in the U.S., are expected to show the highest breast cancer rates in the country.

Breast Neoplasms↗
PubMed2005

The next pandemic: anticipating an overwhelmed health care system.

INTRODUCTION: In September 2005, an overview of current health care system planning efforts was presented to the audience at the Yale University Ethics Symposium on Avian and Pandemic Influenza. The speaker, also the author of this article, provided the audience with a summary of what was being undertaken with the use of federal preparedness funds to improve the overall infrastructure of the health care system. All of Connecticut's 31 acute care hospitals, the Veteran's Administration Hospital in West Haven, Hospital for Special Care, Gaylord Rehabilitation Hospital, Natchaug Psychiatric Hospital, and the state's 13 Community Health Centers are currently recipients of federal preparedness funds. Federal funding for this planning comes from Health Resources and Services Administration, Department of Health and Human Service's National Bioterrorism Hospital Preparedness Program. OBJECTIVES: This article outlines the planning activities around pandemic influenza that the state's health care system partners started in 2004-2005 and also those they are currently participating in or will be participating in the next 12 to 15 months. The article highlights the key objectives and strategies that health care facilities will be using in this planning. There are four major objectives that each health care facility's Emergency Operations Plan must address. They are: increasing bed availability, developing strategies to deal with the potential staffing shortages, developing strategies for dealing with potential critical equipment and pharmaceutical shortages, and, lastly, the implementation of education, training and communication strategies for their health care workers and the public they serve. These plans, and all the activities needed to operationalize the plans, such as education, training, drills, and exercises, will include their key partners, i.e., local health departments, local emergency management, police, fire, and Emergency Medical Services. This article will describe this work plan in detail. METHODS: Descriptive information was obtained through the author's observations and personal experiences, in addition to governmental guidance, reports, and plans. CONCLUSION: The "all-hazards" planning currently being undertaken by the key health care system partners in Connecticut as a result of federal funding for preparedness post 9/11 has fostered great working relationships between these entities and their local, regional, and statewide planning counterparts. Many of the specific grant dollars being provided to these facilities can assist in the planning that must be done for pandemic flu.

Connecticut↗
PubMed1988

Borreliosis in equids in northeastern United States.

During 1982 and 1985, blood samples from 705 equids were examined for antibodies to Borrelia burgdorferi. By indirect immunofluorescence staining, IgM and total immunoglobulin (IgM and IgG) antibodies were detected in 37 (5.3%) and 90 (12.8%) serum specimens, respectively. The geometric mean titer for IgM antibody (140.4) was highest during July, whereas total immunoglobulin ranged from 94.1 in October to 338 in May. Eighty-six equids with total immunoglobulin to B burgdorferi lived in areas of Connecticut where the primary tick vector, Ixodes dammini, was present. Of the 86 equids, 9 from Lyme, Connecticut and Westchester County, New York had antibodies to B burgdorferi and developed limb or joint disorders that resulted in single or recurrent episodes of lameness.

Animals↗