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At least 1,603 records · Page 89Linked to original sources
PubMed1987

Clinical and serologic studies of canine borreliosis.

During 1984 and 1985, blood samples were obtained from 271 dogs that were suspected of having borreliosis. The dogs lived in areas known to be infested with ticks and had been examined because of limb/joint disorders or for unknown illnesses marked by fever, anorexia, or fatigue. Lameness had been the most frequently reported clinical manifestation. Analyses of serum specimens, by an indirect fluorescent antibody (IFA) method or by an ELISA, detected antibodies to Borrelia burgdorferi, the etiologic agent of borreliosis in dogs and of Lyme disease in human beings. Antibody to B burgdorferi was detected in 76.3% of 114 specimens from dogs living in the lower Hudson Valley region of New York State (predominantly Westchester County), in 66.5% of 155 specimens from dogs from southern Connecticut, and in single specimens from dogs from Rhode Island and California. Geometric mean antibody titers peaked during the winter. Results of IFA tests and ELISA were in agreement, but the latter method yielded less variable results, had greater sensitivity, and was more easily standardized. Five dogs from New York State and Connecticut seropositive to B burgdorferi had developed kidney disorders during or after episodes of intermittent lameness. Application of murine monoclonal antibody in an IFA procedure verified the presence of B burgdorferi in renal cortical tissues from one dog.

Animals↗
PubMed1986

Bladder tumor incidence among workers exposed to benzidine: a thirty-year follow-up.

Linkage with records of the Connecticut Tumor Registry was used to determine cancer incidence in a cohort of workers (n = 984) at a benzidine manufacturing facility. Compared to the findings for the Connecticut population, there was a statistically significant excess of bladder tumor among male cohort members [standardized incidence ratio (SIR) = 343; 95% confidence limits (CL) = 148, 676; n = 830], which was confined to those with the highest estimated level of benzidine exposure (SIR = 1,303; CL = 479, 2,839; n = 105). No significantly elevated risks were found for cancers at other anatomic sites in men or at any anatomic sites in women; nor was there any pattern of increasing risk with increasing benzidine exposure for sites other than bladder. In addition, the elevated bladder cancer risk was greater for men first employed during the earliest years of the plant, namely, 1945-49 (SIR = 976; CL = 262, 2,498) as compared to those first employed in 1950-54 (SIR = 213; CL = 3, 1,184) after equalization of duration of follow-up. These results suggest that the major preventive measures instituted around 1950 may have reduced bladder cancer risk in this plant.

Adult↗
PubMed1987

Patient age distribution in thalassemia major: changes from 1973 to 1985.

Major advances have occurred in the treatment and prevention of thalassemia major, but their impact on incidence and survival have not been well assessed. In 1973, a survey was done of the ages of 243 living patients with thalassemia major followed at 12 centers in the United States and Canada. Twenty-two percent were younger than 5 years and 2.1% were older than 25 years of age (mean 11.4 +/- 6.7 [SD] years). In 1985, there were 303 patients at the same centers; 11% were younger than 5 years and 7.9% were older than 25 years (mean 14.2 +/- 7.3 years). A similar pattern was found in Connecticut, characterized by a marked decrease of new cases of thalassemia major during the past 15 years. This was not a result of fewer persons at genetic risk or a change in marital ethnic choices. Eleven of 14 families who had a child with thalassemia major assured that another affected child would not be born by having no more children, using prenatal diagnosis, or having therapeutic abortions. Extensive community programs of education and testing for thalassemia trait in Connecticut may also have contributed to the observed reduction in new cases.

Adolescent↗
PubMed1985

Privileging nurses in a psychiatric hospital.

A privileging system was developed for the nursing department of the Connecticut Valley Hospital, a 658-bed public psychiatric facility in Middletown, Connecticut. The authors discuss the development of the privileging criteria, how the process works, and early responses and results.

Connecticut↗
PubMed1986

Sterilization of infant formula: current practices and recommendations.

Home sterilization of infant formula became a standard of well-baby care in the 1940s. Its purpose was to eliminate bacterial pathogens that could contaminate water and bottles. Public water supplies are now rarely contaminated, and studies have confirmed that sterilization is no longer necessary. Connecticut family physicians and Connecticut mothers were polled and it was found that 48 percent of physicians recommend sterilization and that 54 percent of mothers (using public water supplies) sterilize formula. Formula sterilization recommendations by physicians and sterilization practices by mothers need to be updated.

Connecticut↗
PubMed1978

Oligodendrogliomas in children.

Oligodendrogliomas are quite uncommon in children. In a 41-year period (1935 to 1975) in Connecticut, 12 histologically verified cases of oligodendrogliomas were noted in persons less than 20 years of age, constituting between 1% and 2% of all primary intracranial neoplasms in Connecticut children. Eleven of the neoplasms occurred in the cerebral hemispheres; these cases of cerebral oligodendrogliomas were reviewed and analyzed.

Adolescent↗
PubMed1996

Using admission characteristics to predict short-term mortality from myocardial infarction in elderly patients. Results from the Cooperative Cardiovascular Project.

OBJECTIVE: To develop a prediction model of death within 30 days of hospital admission for Medicare patients with acute myocardial infarction that would permit use of risk-adjusted mortality rates as hospital quality measures. DESIGN: Retrospective cohort study using data created from medical charts and administrative files. SETTING: All acute care hospitals in Alabama, Connecticut, Iowa, or Wisconsin. PATIENTS: A cohort of 14,581 patients with acute myocardial infarction covered by Medicare in 1993. RESULTS: The unadjusted 30-day mortality rate was 21%, ranging from 18% in Connecticut to 23% in Alabama. The 4 largest contributors to variability in mortality rates were mean arterial pressure, age, respiratory rate, and serum urea nitrogen level. The area under the receiver operator characteristic curve was 0.79 in a developmental sample of 10 936 patients and 0.78 in a validation sample of 3645 patients. Based on admission variables, we were able to explain 27% of the variability in 30-day mortality rates. During the index admission, aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and thrombolytic agents were used in 72%, 39%, 32%, and 15% of patients, respectively. Explained variation increased by 6 percentage points to 33% when drug therapies and revascularization procedures performed during the index admission were added to the model predictors. CONCLUSIONS: Short-term mortality remains high for elderly patients with acute myocardial infarction, and a large percentage of variation remains unexplained after controlling for admission severity. Part of the unexplained variability can be explained by the location of the admitting hospital; some of the remaining unexplained variation may reflect differences in quality of care or unmeasured differences in disease severity. Researchers should develop quality indicators based on process measures for acute myocardial infarction and should incorporate these measures into mortality models to determine whether quality accounts for variation in 30-day mortality rates beyond that explained by clinical status at admission.

Aged↗
PubMed1997

Factors associated with client-reported HIV infection among clients entering methadone treatment.

To determine demographic and behavioral factors associated with client-reported HIV infection among new enrollees in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut, we examined ethnographic data and interview data from MMTP clients (N = 674). Clients responded to questions about behaviors in the 30 days before drug treatment. ETHNOGRAPH was used to analyze qualitative data, and logistic regression analysis was used to identify variables associated with client-reported HIV infection. Statistical significance was set at p < .05. The client-reported HIV infection rate was 20% (132/674). Odds ratios for factors associated with client-reported HIV infection were being white (0.53), increase in age (1.07), use of non-injected heroin (0.12), use of injected heroin (6.24), cocaine injection (1.78), sharing of "works" with strangers (2.15), and "safer sex" behavior (4.04). Additionally, 35% of those who did not use illicit drugs reported being seropositive. The qualitative data suggested HIV positive clients were concerned about protecting sex partners, and learning of HIV infection motivated some to stop using drugs. Although some clients engaged in low-risk behaviors, others did not, therefore the potential for HIV transmission among injection drug users (IDUs) in Connecticut and Massachusetts exists. HIV prevention and drug treatment program personnel should reinforce and build on the low-risk behaviors that are acceptable and adopted by some in this population.

Adult↗
PubMed1997

Counseling for physical activity: what primary-care physicians should know.

In Connecticut, 22.1% of the adult population report no physical activity other than activities of daily living. Primary care physicians can play a vital role in the flight against a sedentary lifestyle. As outlined in Healthy People 2000 and the Surgeon General's Report on Physical Activity and Health, the primary-care physician's role in the assessment and advising of physical activity is critical. The primary-care physicians that responded to the Connecticut survey appear to be doing an excellent job in delivering this important message. Recommendations made by the primary-care physician can be a great source of motivation for the patient. The primary-care physician's initial goal should be to get the patient active on a daily basis and than progress to more health-based fitness goals. The patient needs to receive instruction on goal setting, safe exercise tips, and adherence strategies. The primary-care physician's low-cost intervention of advising physical activity can help prevent medical problems in the future. The most current recommendation on physical activity states that, "All U.S. adults should accumulate 30 minutes or more of continuous or intermittent amounts of moderate-intensity physical activity on most, preferably all, days of the week." This latest recommendation offers primary-care physicians a broader range of activities to suggest to their patients. An overwhelming number of research studies indicate that physical activity is a powerful weapon in combating a host of lifestyle-related health problems.

Adult↗
PubMed1976

Pharmaceutical group purchasing cuts costs, expands knowledge.

The CHA-CSHP pharmaceutical group purchasing program has provided several benefits to participating hospitals and related institutions in Connecticut. The program is run by pharmacists and staffed by individuals knowledgeable in good purchasing techniques. Pharmacist compliance has been good because of maximum input into program decisions by all participating pharmacy departments. Pharmaceutical industry participation has been excellent, because each bid invitation includes information on the previous year's purchases by participating hospitals and on the committed volume for the contract period. In addition, the program is self-supporting. Thus, larger hospitals, which would often be able to obtain good pricing independently, are not obliged to support the bulk of this program, as is often the case when participating institutions pay dues based on their bed size. As a result of the pharmaceutical group purchasing plan of the Connecticut Hospital Association, hospitals have received significant benefits in cost savings and shared drug information.

Connecticut↗
PubMed1998

Hospital charges for terminal care of cancer patients dying before age 65.

Cancers are common causes of death before age 65 years, but health care costs have rarely been examined. Data from the statewide population-based Connecticut Tumor Registry were linked with the statewide hospital-discharge database, for cancer patients who died in 1992 before age 65 years. Average cancer-related charges for stays at Connecticut hospitals during the last year of life for lung and breast cancer were $31,000-$37,000 per patient, and total charges were $9 million-$12 million. Trends in the health care system and in patient preferences may affect future hospital charges for terminal care of cancer patients.

Adolescent↗
PubMed1998

The primary care physician and managed care.

I have explored the major options open to PCPs. There are multiple variations on these themes. While the Connecticut market is fluid, one thing is clear, the solutions will vary from place to place. Health-care reorganization is a local phenomenon. Individual doctor groups can have a major influence on the direction of their local market. The future is uncertain, but whatever happens in Connecticut it will be evolutionary. PCPs must understand the realities of the current marketplace and plan a strategy to work with those realities to achieve their long-term goals. The choices we make today will have ramifications flowing far into future decades. PCPs and their patients will have to live with the consequences of these decisions. Please choose wisely.

Connecticut↗
PubMed1998

Validation of a melanoma prognostic model.

BACKGROUND: A "clinically accessible," 4-variable (patient age, patient sex, tumor location, and tumour thickness) prognostic model has been published previously. This model evaluated variables that were commonly available to the clinician. Because models are heuristic, validity of a prognostic model should be evaluated in a population different from the original population. OBJECTIVE: To evaluate the external validity of this 4-variable melanoma prognostic model. DESIGN: To estimate the external validity of this model, we used a population-based cohort of individuals with melanoma. We also evaluated a 1-variable model (tumor thickness). Estimates of the external validity of these logistic regression models were made using the c statistic and the Brier score. SETTINGS AND PATIENTS: A total of 1261 patients with melanoma evaluated in a multispecialty, university-based practice and 650 patients with melanoma from throughout Connecticut. MAIN OUTCOME MEASURE: Death from melanoma within 5 years of diagnosis. RESULTS: The c statistics for the 4-variable model were 0.86 (95% confidence interval [CI], 0.83-0.89) for the university-based practice data set and 0.81 (95% CI, 0.75-0.86) for the Connecticut data set. For thickness alone, the c statistics were 0.83 (95% CI, 0.80-0.86) and 0.79 (95% CI, 0.74-0.85), respectively. Brier scores for the 4-variable model were 0.09 (95% CI, 0.08-0.10) and 0.08 (95% CI, 0.06-0.09) and for the 1-variable model were 0.09 (95% CI, 0.08-0.10) and 0.08 (95% CI, 0.07-0.10), respectively. No significant differences exist between the data sets for the 4- and 1-variable models. CONCLUSIONS: The 4- and 1-variable models are generalizable. The simpler 1-variable model--tumor thickness--can be used with a relatively small loss in accuracy.

Female↗
PubMed2001

Foster care placement improves children's functioning.

OBJECTIVE: To examine changes in reported functioning over a 12-month follow-up period and predictors of those changes for a cohort of young children enrolled in foster care. DESIGN: Data came from a longitudinal follow-up of a cohort of young children entering foster care in one Connecticut region. These data were originally assembled to evaluate the effectiveness of a specialized set of services designed to provide a baseline multidisciplinary assessment and ongoing monitoring for young children entering foster care. SETTING AND PARTICIPANTS: From February 1, 1992, through July 31, 1993, all young children (N = 120) entering foster care in one Connecticut region were enrolled in this study. Children were assessed at entry into care and at 6 and 12 months after entry. Participation rates exceeded 90% at each follow-up period. MAIN OUTCOME MEASURES: The principal outcome of interest for these analyses is 12-month functioning as measured by the Vineland Adaptive Behavior Scale (VABS) scores completed by their foster mothers. RESULTS: At entry into foster care, children ranged in age from 11 to 76 months, were evenly divided by sex, and had a mean VABS score of 79.5 signifying functioning below the average range. At 6 months children gained an average of 7.87 points on their VABS score. By 12 months children showed an average change of 9.65 points, for a mean VABS score of 94.5, well within the nationally normed average range. The multivariate linear model predicting the 12-month VABS score showed that, controlling for the baseline VABS score, when children who were abused, older at placement, female, of African American ethnicity, spent more time in foster care, and had fewer recommended services while in care, they were more likely to show improvement on the foster mother-reported VABS evaluation. CONCLUSIONS: These results demonstrate that children's reported functioning improves over the course of placement in foster care and that sociodemographic characteristics, reason for placement, length of time in foster care, and fewer recommended services at entry into foster care identified children who were more likely to improve. These results argue for a careful examination of the foster care environment to better understand which aspects of the environment contribute to improved foster mother reported functioning. Such understanding will be critical for the care and development of maltreated children.

Child↗
PubMed1994

Geographic patterns of fatal abuse or neglect in children younger than 5 years old, United States, 1979 to 1988.

OBJECTIVE: To examine geographic patterns of fatal child abuse or neglect (CAN) among children younger than 5 years old. DESIGN: A death certificate-based model to estimate the occurrence of fatal CAN. SETTING: United States, 1979 to 1988. PARTICIPANTS: The population of children younger than 5 years old. INTERVENTIONS: None. MAIN RESULTS: We estimate that from 868 to 1815 deaths annually occur among children younger than 5 years old from CAN. The lower figure is the estimate of confirmed CAN, and the higher is the estimate of the sum of confirmed, probable, and possible CAN. Death rates were highest in the South and West, intermediate in the North Central, and lowest in the Northeast. A threefold difference was noted between rates in the lowest- and highest-ranking states (ie, Connecticut, 2.9 to 5.2 per 100,000, and Nevada, 6.7 to 15.4 per 100,000, respectively). When the 39 largest metropolitan areas were ranked, a similar variation between the lowest and the highest was observed (ie, Boston, Mass, 2.7 to 5.5 per 100,000, and Phoenix, Ariz, 6.6 to 15.5 per 100,000, respectively). CONCLUSION: Understanding the sizable geographic variation in CAN deaths rates could lead to effective interventions. If the US fatality rate were reduced to that of Connecticut, between 434 and 908 fewer CAN deaths might occur annually.

Cause of Death↗
PubMed2000

Long-term outcomes of persons with Lyme disease.

CONTEXT: Few data exist about the long-term outcomes of patients with Lyme disease. OBJECTIVE: To assess the long-term outcomes of patients with Lyme disease. DESIGN: Two-part project including a community-based longitudinal cohort study and a matched cohort study. SETTING AND PARTICIPANTS: Six hundred seventy-eight patients identified from a random sample of all reports of Connecticut residents with suspected Lyme disease submitted to the Connecticut Department of Public Health from 1984-1991 were evaluated in the longitudinal study; for a random subsample of 212 patients from the larger study, 212 age-matched controls without Lyme disease also were enrolled. MAIN OUTCOME MEASURES: Self-reports or parents' reports of symptoms and ability to perform certain daily activities since diagnosis of Lyme disease; scores on the 36-Item Short-Form Health Survey and the Center for Epidemiologic Studies-Depression scale, for adults, by case-definition status and between patients and controls. RESULTS: Of the 678 patients, 51.6% were female, 34.4% were children, and 64.3% met the national surveillance case definition for Lyme disease. Most patients (85.6%) were treated with antimicrobial agents. Interviews were conducted a median of 51 months after diagnosis (range, 15-135 months). An increased frequency of symptoms (eg, pain, fatigue) or of difficulty with daily activities (eg, performing housework, exercising) was reported by 69% of the patients, although few (19%) of these problems were attributed to Lyme disease. Whenever there was a statistically significant difference in the frequencies of either increased symptoms or increased difficulties with typical activities between those who did or did not meet the surveillance case definition, in all instances the greater frequency of problems was in the group that did not meet the case definition. The frequencies of reports of both increased symptoms and increased difficulties with typical activities among patients who had been diagnosed as having Lyme disease were similar to those among age-matched controls without Lyme disease. CONCLUSIONS: In this cohort, although many patients reported increases in symptoms and/or increased difficulties with typical daily activities between 1 and 11 years after diagnosis of Lyme disease, the frequencies of these reports were similar to the frequencies of such reports among age-matched controls without Lyme disease.

Adult↗
PubMed1997

Occupational exposure to machining fluids and laryngeal cancer risk: contrasting results using two separate control groups.

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls may have differed from that of the population controls.

Case-Control Studies↗
PubMed1981

Malignant melanoma of the skin occurring during pregnancy.

The clinical course of melanoma of the skin diagnosed during pregnancy was compared with a control population of women with melanoma that occurred during the childbearing years, as recorded by the Connecticut Tumor Registry. The survival at three and five years for the 12 patients whose melanoma developed during pregnancy was significantly worse than for 175 nonpregnant controls (five-year survival 55% for pregnant women compared with 83% for nonpregnant women, P less than 0.05). Melanoma during pregnancy tended to occur more often on the trunk, a prognostically poor site, and at more advanced stage of disease than in nonpregnant women. However, when pregnant patients were matched to random, nonpregnant case-controls by age, anatomic site of primary lesion, and stage at diagnosis, three- and five-year survivals were not different. The number of pregnant women observed among this group of women was not substantially higher than expected, when estimated from Connecticut live birth rates: 13.3 pregnancies were expected and 12 pregnant women were actually observed. However, an unknown number of pregnancies end in abortion, making more exact estimates impossible. Melanoma occurring during pregnancy usually carries a poor prognosis, but once the disease is diagnosed, the course is not worse than expected considering stage of disease and primary site.

Adult↗