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PubMed1989

Co-circulation of multiple Colorado tick fever virus genotypes.

Colorado tick fever (CTF) virus, family Reoviridae, genus Orbivirus, contains 12 genes distinguishable by polyacrylamide gel electrophoresis (PAGE). Multiple genotypes of CTF virus were isolated at 3 field sites in Colorado in 1985. Five genotypes were found at Campos Cabin, 2 at Drake, and 6 at Rocky Mountain National Park. Virus isolations were made in 1985 from 6 patients with CTF. These isolates were distinct from each other and the field isolates. Although the CTF isolates were different by PAGE profile, the majority of the 12 genes were highly conserved among the 1985 isolates and a Florio isolate (FMA). Only genes 4 and 6 were variant among the 1985 CTF isolates and FMA, and no unique genes were identified. In 1986, a follow-up field survey was done at the Campos Cabin site. Of the 3 CTF PAGE genotypes obtained, 2 exhibited PAGE profiles which were different from the 1985 isolates. One isolate may have resulted from the reassortment of genes from 2 of the isolates circulating at Campos Cabin in 1985.

Animals↗
PubMed1998

Mental health costs and outcomes under alternative capitation systems in Colorado: early results.

BACKGROUND: This study presents preliminary findings for the first nine months of the State of Colorado USA Medicaid capitation Pilot Project. Two different models of capitation (model I and model II) are compared with fee for service (FFS) in providing services to severely and persistently mentally ill adults. In model I the state's mental health authority contracts with community mental health centers (CMHCs) who both manage the care and deliver mental health services, while in model II the state contracted with a joint venture between a for-profit managed care firm who manage the care with either a single CMHC or an alliance of CMHCs who deliver the mental health services. AIMS: Our objective is to examine utilization, cost and outcomes of inpatient and outpatient (including community based) services before and after the implementation of a capitated payment system for Colorado's Medicaid mental health services compared to services that remained under FFS reimbursement. METHODS: The stratified, random sample includes 513 consumers (188 for model I, 179 for model II, and 146 for FFS). Consumer outcomes were collected by trained interviewers and include 17 measures of symptoms, health status, functioning, quality of life and consumer satisfaction. Utilization and cost of services are from the Medicaid claims data and a shadow billing data system (post-capitation) designed by Colorado. The first step of the two-step regression procedure adjusts for the presence of individuals with use or no service use during the specified time while the second step, ordinary least-squares regression, is applied to the sample who utilized services. RESULTS: These preliminary findings indicate consistent reductions in inpatient user costs and probability of outpatient use under capitation. Combining all services, there are consistent reductions in the probability of use in both models: model I had significantly higher initial probability of use for any service. Only model II showed a statistically significant decrease in post-capitation overall user costs, but they were initially higher than model I or FFS. Estimated total cost per person for model I suggests virtually no change from the pre- to post-capitation period. Model II had the highest pre-capitation and the lowest post-capitation estimated cost per person. Examination of pre measures of outcomes across capitated areas suggest that samples drawn from the FFS, model I and model II areas were comparable in severity of psychiatric symptoms, functioning, health status and quality of life. No changes were found in outcomes. DISCUSSION: These early findings are consistent with the limited literature on capitation. Both studies of capitation integrated with medical care and those specific to mental health settings did not find adverse changes in outcomes compared to FFS. Limitations include the short follow-up period, lack of detail and possible under-reporting of outpatient services provided by the shadow billing data system. CONCLUSIONS: For the short term, it is concluded that capitation can reduce service cost per person without significant change in clinical status. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Implications are unclear until we can determine whether (i) reductions in the numbers receiving service indicates favorable consumer outcomes or reductions in access and (ii) lack of change in consumer outcomes is due to the benefits of capitation or the lack of sensitivity of the outcome measures. IMPLICATIONS FOR HEALTH CARE POLICY FORMULATION: Implications are premature for these early findings. IMPLICATIONS FOR FUTURE RESEARCH: Future research should include longer follow-up as well as analysis of long-term consequences for both cost savings and clinical outcomes.

Journal Article↗
PubMed1985

Immunocytochemical localization of peptidergic neurons and neurosecretory cells in the neuro-endocrine system of the Colorado potato beetle with antisera to vertebrate regulatory peptides.

A large number of antisera to regulatory vertebrate peptides was tested immunocytochemically on the nervous system of the Colorado potato beetle to further characterize the peptidergic cells of the neuro-endocrine system and to reveal cells participating in endocrine control mechanisms. Neurons, neurosecretory cells, axons and axon terminals were revealed by antisera to ACTH, gastrin, CCK, alpha-endorphin, beta-endorphin, gamma 1-MSH, insulin, motilin, human calcitonin, growth hormone, somatostatin, CRF, ovine prolactin and rat prolactin. Together with previously described results these findings demonstrate that at least 19 different peptidergic cell types are present in the Colorado potato beetle. Several of these cell types are identical with the known neurosecretory cells, while others have not been identified before. The functions of the immunoreactive neurons are as yet unclear, although in two cases the localization of these cells gives some clues. Thus the lateral neurosecretory cells, which are immunoreactive with antisera to beta-endorphin and ovine prolactin, may regulate corpus allatum activity, whereas a CRF immunoreactive substance seems to be used as neurotransmitter by antennal receptors. These immunocytochemical findings do not imply that the immunoreactive substances are evolutionarily related to the vertebrate peptides to which the antisera were raised. It is postulated that if the part of the substance recognized by a certain antiserum is functionally important for the insect, which should be so if the insect peptide is evolutionarily related to its vertebrate homologue, the antiserum should reveal homologous cells in different insect species. The consequence of this hypothesis is, that if an antiserum does not reveal homologous neurons in different insect species, the immunologically demonstrated substance is probably of little physiological importance, and will not be related evolutionarily to the vertebrate analogue. The positive immunocytochemical results in the Colorado potato beetle are discussed in relation to these considerations.

Animals↗
PubMed2001

Partial purification of a novel insect antidiuretic factor from the Colorado potato beetle, Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae), which acts on Malpighian tubules.

In this study, we report for the first time the presence of an antidiuretic factor in the head of the Colorado potato beetle (Leptinotarsa decemlineata (Say)) which acts directly on Malpighian tubules. Biologically active fractions were isolated from the head and separated using molecular weight filtration and high-performance liquid chromatography (HPLC). The resulting fractions were tested for their antidiuretic activity on single isolated Malpighian tubules. Antidiuretic activity was found in the 25% acetonitrile Sep-Pak fraction and the Cn-2 (3000-10,000 MW) and Cn-3 (<3000 MW) fractions, suggesting that the antidiuretic factor was probably a peptide of 25 to 50 amino acids. The antidiuretic factor was very potent, since after five successive fractionations on two different HPLC columns, a high level of inhibition (63%) of fluid secretion by Malpighian tubules could be observed at low dose (0.14 head-equivalent/microl). The antidiuretic factor isolated from the head of the Colorado potato beetle was not affected by repeated freezing and thawing but was sensitive to heat. The differences observed between the Colorado potato beetle antidiuretic factor and other insect diuretic and antidiuretic factors may indicate the possibility of a novel family of water regulation hormones in insects.

Agriculture↗
PubMed2005

Accumulation and perchlorate exposure potential of lettuce produced in the Lower Colorado River region.

The Colorado River is contaminated with perchlorate concentrations of 1.5-8 microg/L, an anion linked to thyroid dysfunction. Over 90% of the lettuce (Lactuca sativa L.) consumed during the winter months in the United States is produced in the Lower Colorado River region. Studies were conducted in this region to survey the potential for lettuce perchlorate accumulation and estimate potential human exposure to perchlorate from lettuce. Total uptake of perchlorate in the above-ground plant of iceberg lettuce was approximately 5 g/ha. Exposure estimates ranged from 0.45 to 1.8 microg/day depending on lettuce types and trimming. For all lettuce types, hypothetical exposures were less than 4% of the reference dose recommended by the National Academy of Sciences. Results show the relative iodide uptake inhibition potential because of lettuce nitrate was 2 orders of magnitude greater than that associated with the corresponding trace levels of perchlorate. These data support the conclusion that potential perchlorate exposures from lettuce irrigated with Colorado River water are negligible relative to acute or long-term harmful amounts.

Arizona↗
PubMed1995

Site-specific integrated pest management for high value crops: sample units for map generation using the Colorado potato beetle (Coleoptera: Chrysomelidae) as a model system.

Site-specific agriculture uses maps to optimize within-field placement of agricultural practices. This technology introduces the potential to optimize pest management by varying pesticide or other inputs to better match within-field variation in pest density. Current sampling plans are designed to estimate mean density and may not be suitable for mapping, although useful sampling plans could be developed for map generation for integrated pest management. Using Colorado potato beetle, Leptinotarsa decemlineata (Say), adults, larvae, and egg masses as model systems, the influence of the sample unit on map validity was explored. Adapting currently used sampling plans for potato integrated pest management by spatially referencing each sampled stem failed to resolve spatial dependence and resulted in maps with poor reliability. Increasing the sample unit improved resolution of spatial dependence and map reliability for each life stage. A distance-walk sample unit for adult and late instar Colorado potato beetles which has high potential for map generation is introduced. Using this sample unit, generalizations about Colorado potato beetle spatial dependence are made to discuss issues of developing sampling programs for map generation. An iterative process of sampling, spatial analysis, and error analysis is suggested for evaluating sample units for mapping pest density in high value crops.

Animals↗
PubMedDate not supplied

Development of a new pain scale: Colorado Behavioral Numerical Pain Scale for sedated adult patients undergoing gastrointestinal procedures.

A limited number of studies have addressed pain assessment among sedated patients undergoing a gastrointestinal examination. The Colorado Behavioral Numerical Pain Scale is a quick, simple tool that can provide an estimation of the patient's comfort level while sedated. Multiple studies completed in intensive care unit and postanesthesia care unit settings provide ample evidence of the accuracy of behavioral pain scales ratings. In developing the Colorado Behavioral Numerical Pain Scale, experienced endoscopy nurses provided suggestions and modifications of descriptive words for behavioral assessment of pain selected from the relevant literature. Three nurses simultaneously rated pain using the scale for 30 procedures. Interrater reliability was high with 82% of observations in total agreement and 17% having one of the three persons disagreeing on the rating. Nurses from four hospitals and one ambulatory facility also evaluated the Colorado Behavioral Numerical Pain Scale tool. In this evaluation, 98% of the 52 respondents agreed that the words described what they observed during a gastrointestinal examination and 94% felt it was a better descriptor of pain than a patient self-report numerical scale. Assessment of pain for the sedated patient undergoing gastrointestinal procedures is often difficult due to the patient's inability to report pain levels. The sedated patient undergoing painful procedures depends on the nurse to interpret physical signs to quantify his or her distress. The Acute Pain Management Guidelines (AHCPR, 1992) promotes the use of both physiological and behavioral responses to pain for assessment when self-report is absent. While an individual's self-report of pain intensity and distress is the most accurate assessment measurement, the validity of a sedated patient's elicited response about pain is questionable. It is the nurse, through observation, who attempts to assess the sedated individual's pain levels.

Adult↗
PubMed2000

A three-dimensional radiographic comparison of Cotrel-Dubousset and Colorado instrumentations for the correction of idiopathic scoliosis.

STUDY DESIGN: A prospective clinical study comparing two instrumentation systems for the correction of idiopathic scoliosis. OBJECTIVES: To measure the short-term three-dimensional changes in the shape of the spine after corrective surgery and compare the Cotrel-Dubousset instrumentation to the more recent Colorado instrumentation to determine whether one system provides better three-dimensional correction. SUMMARY OF BACKGROUND DATA: Adequate three-dimensional correction of scoliotic deformities has been reported with the Cortrel-Dubousset instrumentation system. During the past decade, a new generation of more versatile and user-friendly spinal implants has appeared, but there are no reports available to indicate whether similar or better correction can be obtained with these newer systems. METHODS: The three-dimensional geometry of the thoracic and lumbar spine was documented in the standing position using a three-dimensional reconstruction technique based on multiplanar radiography in 67 adolescents with idiopathic scoliosis undergoing correction by a posterior approach. Changes in spinal shape were measured 3 days before and 1 month after the surgery in 31 patients with Cotrel-Dubousset instrumentation and 36 patients with Colorado instrumentation. RESULTS: In both groups, adequate three-dimensional correction of the scoliotic deformities was documented for thoracic and lumbar curves, with significant changes in the frontal plane, in the plane of maximum curvature, and in its orientation. When comparing both groups, better correction was obtained in the frontal plane with the Colorado instrumentation (65% vs. 48% with Cotrel-Dubousset), a finding that may be explained by the significantly greater proportion of pedicle screws used in this group. CONCLUSION: Both instrumentation techniques achieve an effective and comparable three-dimensional correction of the scoliotic deformities.

Adolescent↗
PubMed2002

Breaking a paradigm: male-produced aggregation pheromone for the Colorado potato beetle.

A male-produced aggregation pheromone was identified for the Colorado potato beetle Leptinotarsa decemlineata (Say) (Coleoptera: Chrysomelidae). While male beetles produced only minor amounts of the pheromone, its production could be enhanced by topical application of juvenile hormone III (JH III) (eightfold), by antennectomy (40-fold) or by the combined treatment of JH III and antennectomy (almost 200-fold); this enhancement enabled the identification of the compound as (S)-3,7-dimethyl-2-oxo-oct-6-ene-1,3-diol [(S)-CPB I], a unique structure for an insect pheromone. Antennal receptors of both sexes responded selectively to the (S)-enantiomer. Both male and female Colorado potato beetles were attracted to serial source loads of (S)-CPB I in laboratory bioassays; (R)-CPB I was inactive or inhibitory, as demonstrated by the inactivity of the racemate. This is the first identification of a pheromone for the Colorado potato beetle and differs from the paradigm of a female-produced pheromone for this insect. The attractant is also the first male-produced pheromone identified for the Chrysomelidae. The discovery that both JH III and antennectomy increase levels of the pheromone (S)-CPB I indicates the existence of a feedback system involving antennal input, and this system may be under hormonal control.

Animals↗
PubMed2006

Host usage and seasonal activity patterns of Ixodes kingi and I. sculptus (Acari: Ixodidae) nymphs in a Colorado prairie landscape, with a summary of published North American host records for all life stages.

We examined host usage and seasonal activity patterns of the nymphal stage of the ticks Ixodes kingi and I. sculptus within a prairie rodent community in north-central Colorado. Ixodes kingi was commonly encountered on both northern grasshopper mice (Onychomys leucogaster) and thirteen-lined ground squirrels (Spermophilus tridecemlineatus), whereas I. sculptus frequently infested S. tridecemlineatus but was absent from O. leucogaster. Low numbers of ticks of both species were collected from deer mice (Peromyscus maniculatus) and Ord's kangaroo rats (Dipodomys ordii). Nymphal loads of I. kingi and I. sculptus increased dramatically on commonly infested rodent species from spring (May-June) to summer (July-August). Further, rodents trapped on prairie-dog towns tended to experience increased nymphal loads of I. kingi (O. leucogaster, S. tridecemlineatus) but decreased loads of I. sculptus (S. tridecemlineatus) following plague epizootics among prairie dog populations. A summary of published North American host records revealed that I. kingi has been recorded from humans, domestic animals (cat, dog), 17 species of carnivores, 40 species of rodents, and four species of lagomorphs, and that I. sculptus has been recorded from humans, domestic animals (cat, dog, goat), 13 species of carnivores, 34 species of rodents, and three species of lagomorphs. In accordance with our observations from Colorado, I. kingi commonly has been found to infest heteromyid and murid rodents (such as grasshopper mice), whereas I. sculptus most frequently has been collected from ground-dwelling sciurid rodents, especially Spermophilus ground squirrels. The potential roles of I. kingi and I. sculptus as enzootic vectors of human pathogens, particularly the agents of tularemia (Francisella tularensis), Q fever (Coxiella burnetii), and Colorado tick fever (CTF virus), are discussed.

Animals↗
PubMed1986

[Enzyme systems of insecticide detoxication in the Colorado beetle].

The activity of three enzymatic systems of xenobiotic metabolism (cytochrome P-450-dependent monooxygenases, non-specific esterases and glutathione S-transferases) was studied at different stages of development of the Colorado potato beetle (Leptinotarsa decemlineata). Significant sex and ontogenetic differences in the content of cytochrome P-450, position of maxima of CO-difference spectra of the cytochrome P-450 reduced form and substrate specificity of cytochrome P-450 were revealed. The activity of non-specific esterases was shown to increase depending on the age of larvae. The insecticide 1-naphtholenol methylcarbamate which is metabolized by the system of cytochrome P-450-dependent monooxygenases is more toxic in the larvae than at the imago stage, which is correlated with the activity of this system at different stages of ontogenesis. The microsomal monooxygenase inhibitor, piperonylbutoxide, increases the insecticide toxicity in the Colorado beetle imago more than 2-fold. The experimental results testify to different contribution of the detoxication systems to the sensitivity of the Colorado beetle to insecticides at various metamorphosis stages.

Animals↗
PubMed1997

Isolation, purification, and characterization of a neutral Mg(2+)-dependent deoxyribonuclease of the Colorado potato beetle Leptinotarsa decemlineata Say.

A neutral Mg(2+)-dependent deoxyribonuclease from the Colorado potato beetle was isolated and characterized in physicochemical terms. An electrophoretically homogeneous preparation of the enzyme was obtained using salt fractionation, Sephadex G-100 gel filtration, and subsequent preparative isoelectrofocusing in an Ultrodex layer. The molecular weight of the purified DNase preparation (with a purification degree of 104) and its isoelectric point were 100 kD and 9.1, respectively. The enzyme activity was maximal at pH 7.2 and 46 degrees C in the presence of 10 mM Mg2+. The DNase of the Colorado beetle preferentially hydrolysed denatured DNA via the endonuclease pathway, degrading the substrate to oligonucleoside-3'-phosphates. As far as the physical and chemical properties are concerned, this Colorado beetle DNase seems different from previously investigated DNases of other insect species.

Animals↗
PubMed1994

Colorado tick fever in a resident of New York City.

When a traveler returns from abroad with a febrile illness, clinicians appropriately concern themselves with a potentially vast array of diagnostic exotica. The patient we describe herein did not leave the United States but nevertheless posed the same clinical dilemma after returning home to New York City from the western United States. This case of Colorado tick fever, acquired on the Utah-Colorado border and first expressed in Manhattan, serves as a useful reminder of the importance of taking a careful travel history for national as well as international travelers.

Antibodies, Viral↗
PubMed2003

Recombinant VP7-based enzyme-linked immunosorbent assay for detection of immunoglobulin G antibodies to Colorado tick fever virus.

VP6, VP7, VP9, VP10, VP11, and VP12 of Colorado tick fever virus (CTF virus), a virus member of the genus Coltivirus, family Reoviridae, were expressed in bacteria with the pGEX-4T-2 vector. A partial sequence of VP7 (designated pVP7) was chosen to elaborate an enzyme-linked immunosorbent assay (ELISA) for detecting anti-CTF virus immunoglobulin G (IgG) antibodies in humans. This was based on two observations: (i) among all expressed proteins, pVP7 showed the highest immunoreactivity to an anti-CTF virus hyperimmune ascitic fluid; (ii) to provide the highest selectivity of antibody detection, the expressed sequence was chosen within a region which is highly divergent (49% amino acid identity) from the homologous sequence of another coltivirus, the Eyach virus. The pVP7 ELISA was evaluated with 368 serum samples from French blood donors and found to provide 98.1% specificity. Assays with the Calisher set of human serum samples, positive for anti-CTF virus antibodies (C. H. Calisher, J. D. Poland, S. B. Calisher, and L. A Warmoth, J. Clin. Microbiol. 22:84-88, 1985), showed that the pVP7 ELISA provided 100% sensitivity for the tested population. After elaboration of recombinant-protein-based ELISAs for diagnosis of infections with members of the viral genera Orbivirus, Orthoreovirus, and Rotavirus, it was shown that a recombinant protein could be used to detect antibodies to the human pathogen Colorado tick fever virus.

Antibodies, Viral↗
PubMed1977

Tick-borne diseases in the United States: Rocky Mountain spotted fever and Colorado tick fever. A review.

The historical, clinical, ecological, and epidemiological features of Rocky Mountain spotted fever and Colorado tick fever, the two important tick-borne diseases in the United States, are reviewed. Rocky Mountain spotted fever, once considered a disease of the past, has again become a measurable public health problem. Its nationwide incidence has steadily increased since 1960 and has reached record proportions in 1976. The various factors responsible for this trend as well as for the mortality rates, which in spite of availability of effective antibiotics ranges from 5 to 10%, are discussed. Education of the public about ticks and their potential role as vectors of Rickettsia rickettsii and/or Colorado tick fever virus, and about the clinical manifestations of Rocky Mountain spotted fever, is considered the best means for preventing high incidence and mortality from these diseases.

Antibodies, Viral↗
PubMed2005

Prehospital and in-hospital mortality: a comparison of intentional and unintentional traumatic brain injuries in Colorado children.

OBJECTIVES: To describe the incidence and case-fatality rates of traumatic brain injury (TBI) in young children in Colorado, to compare these injuries based on intentionality and outcome (prehospital death, in-hospital death, or survival), and to model the association of intentionality with TBI-related mortality. METHODS: Cases were drawn from the 1994-2002 Colorado Traumatic Brain Injury Surveillance System. Incidence and case-fatality rates for intentional and unintentional TBI were calculated. We performed univariate comparisons based on the intentionality and outcome of the TBI. Multivariate logistic regression was used to estimate the association of intentionality and mortality, controlling for injury severity. RESULTS: Of the 1333 children aged 0 to 36 months with TBI, 340 had intentional and 993 had unintentional TBI. Incidence for intentional and unintentional TBI was 16.1 and 47.0 per 100,000, respectively. Children with intentional TBI had a higher case-fatality rate, in-hospital death rate, and injury severity. Intentional TBI deaths were twice as likely to occur in hospital than prehospital, whereas unintentional TBI deaths were twice as likely to occur prehospital. Intentionality was significantly associated with mortality, with the effect increasing with increasing age. CONCLUSION: Intentionality--independent of severity--raises the mortality of TBI in young children.

Accidents↗
PubMed1996

Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992.

OBJECTIVES: To investigate the association between maternal age and other risk factors and infant injury deaths in the state of Colorado from 1986 to 1992. DESIGN: A retrospective cohort design was used to compare rates of unintentional and intentional infant injury mortality by maternal age group. A case-control design explored the importance of various risk factors, particularly maternal age, using multivariate logistic regression. PARTICIPANTS: The 2 case groups comprised all unintentional and intentional injury deaths in the first year of life. The control group was a random sample of both survivors and noninjury deaths selected from the entire birth cohort. RESULTS: The infant injury mortality rate for the 322766 live births in Colorado from 1986 to 1992 was 3.1 per 10000. Intentional injury death rates were highest for infants of teenaged mothers, peaking at 10.5 per 10000 live births for mothers aged 16 years. Unintentional injury death rates were highest for infants of mothers aged 20 to 24 years, peaking at 3.7 per 10000 live births for 22-year-old mothers. For intentional injury death, maternal marital status had a significant impact on maternal age; compared with the baseline group of married mothers older than 24 years, significantly higher risks were observed for infants of teenagers who were married (odds ratio [OR] = 32.0; 95% confidence interval[CI], 9.9-104.0) but also in infants of older mothers who were unmarried (OR = 3.6; 95% CI, 1.0-13.0 for unmarried mothers aged 20-24 years and (OR = 7.7; 95% CI, 2.4-25.0 for those > 24 years). Black race (OR = 3.5; 95% CI, 1.4-9.4) was also associated with intentional injury death. For unintentional injury death, the highest risk was for infants of mothers aged 20 to 24 years and unmarried (OR = 3.9; 95% CI, 1.7-9.3). Risk was also elevated for infants of married teenaged mothers (OR = 3.5; 95% CI, 0.7-17.8) but was not significantly different from the baseline group for unmarried teenagers, married 20- to 24-year-old mothers, or unmarried mothers aged 25 years or older. Risk was increased by the presence of older siblings (OR = 1.5 per sibling; 95% CI, 1.2-2.0). CONCLUSIONS: Maternal age and marital status significantly affect the rate of both unintentional and intentional infant injury mortality. These results suggest that child abuse prevention strategies should be targeted to teenaged mothers, and that strategies designed to prevent unintentional injuries should focus particularly on parents or caretakers of infants born to unmarried mothers in their early 20s as well as married teenagers.

Adult↗
PubMed1997

Diagnostic practice and the estimated prevalence of craniosynostosis in Colorado.

BACKGROUND: In the late 1980s, evidence of an epidemic of craniosynostosis in Colorado included reports of clusters from selected high-altitude communities and an investigation showing the high and rapidly rising rates of surgically corrected synostosis. Some evidence suggested that local diagnostic practice could account for the epidemic. OBJECTIVE: To determine the contributions of any excess rates of disease occurrence, surgery-based ascertainment, and diagnosis to the reported epidemic. DESIGN: Population-based birth prevalence study with diagnostic evaluation. SETTING: The Colorado Department of Health, April 15, 1986, to July 14, 1989. PATIENTS OR OTHER PARTICIPANTS: Children in the Craniosynostosis Registry or state birth record files. MAIN OUTCOME MEASURES: Birth prevalence was estimated from registry and birth record data; case classification by suture type and malformation patterns were determined by review of radiographs and medical records. RESULTS: The period birth prevalence of radiographically confirmed nonsyndromic synostosis was 14.1 per 10,000 live births. Of a total of 605 children, 307 (51%) had definite radiographic evidence of synostosis, for which the intrarater reliability was good (except for the coronal suture on plain films) and the interrater reliability was fair or good (except for the metopic suture on plain films). Between the first and third years, case reports fell from 347 to 103. CONCLUSIONS: Diagnostic criteria strongly influenced the rate of synostosis. The rate of radiographically confirmed synostosis was within the range of published estimates. Low diagnostic thresholds, which changed over time, created the semblance of a severe statewide epidemic and may have obscured excess rates of disease at high altitude.

Colorado↗