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At least 163 records · Page 9Linked to original sources
PubMed1992

Time trend and age-period-cohort effects on incidence of esophageal cancer in Connecticut, 1935-89.

The purpose of this study was to examine the incidence pattern of esophageal cancer in Connecticut (USA) during the past decades, and to identify components of birth cohort, period, and and age as determinants of the observed time trends by regression modelling. This study is based on all of the esophageal cancer cases reported to the Connecticut Tumor Registry between 1935 and 1989. A total of 6,310 incident cases were included. Results indicate that among males, the overall age-adjusted incidence rate of esophageal cancer increased after 1935 and peaked between 1955 and 1959. Since then, incidence rates have been relatively stable. Among females, the overall esophageal cancer rate has not changed markedly since 1935. Analysis by histologic type indicates that the incidence rate of squamous cell carcinoma has been declining in this population; adenocarcinoma, however, showed a continuous increase. A fivefold increase among males and a threefold increase among females were observed for adenocarcinoma of the esophagus between 1970 and 1989. If cancers of the esophagus and gastric cardia are considered together, the incidence rate of adenocarcinoma exceeds that of squamous cell carcinoma among males during 1985-89. The observed increasing trend for adenocarcinoma of the esophagus is mainly from cancers arising in the lower third of the esophagus and primarily among Whites, especially White males. The results from regression modeling indicate that both period and birth cohort may have contributed to the observed increasing trend, and adenocarcinoma of the esophagus is likely to increase continuously in this population in the coming years.

Adenocarcinoma↗
PubMed1986

Telephone transmission of fetal heart rate monitor data. The experience at the University of Connecticut Health Center.

This report reviews the experience at the University of Connecticut Health Center using the Fetal Assessment Consultative Transmission Service (FACTS) system during a 2 1/2-year period. This system, which permits direct transmission of antepartum and/or intrapartum fetal heart rate tracings via a telephone line, allows the obstetric staffs of smaller community hospitals to obtain an immediate consultation from the University of Connecticut Health Center on a 24 hour per day basis. A total of 511 fetal heart rate tracings were analyzed. Two hundred forty-five were intrapartum, 206 antepartum, and 60 were transmitted for educational purposes. The results indicate an imperative need for such a service from a tertiary care center to improve the quality of regional perinatal care and to determine the future direction of the regional educational program for physicians and nurses.

Connecticut↗
PubMed1990

Infection control practices in Connecticut's skilled nursing facilities.

Questionnaires were sent to all skilled nursing homes in Connecticut as part of a larger study of nosocomial infections, infection risks, and infection control programs. This article describes surveillance practices, isolation practices, control measures, and employee health activities of skilled nursing homes in Connecticut. The overwhelming majority of skilled nursing homes used written criteria to determine nosocomial infections, and all undertook surveillance; the majority did surveillance at least weekly and 21% did on a daily basis. The most frequent source of information for reporting infections were microbiology reports and information from the charge nurse. Three fourths of the skilled nursing homes stated that the responsibility of reporting communicable disease is that of the infection control practitioner. Two thirds of the skilled nursing homes stated that they had policies on the reporting of isolation practices, including the refusal or acceptance of patients with infections; 38% had residents under isolation precautions. Of all the patient care control measures, only that of changing urinary catheters on a routine basis was associated with facility size. More than 90% of facilities reported having an employee health program, but the benefit was limited.

Connecticut↗
PubMed1990

Infection control practitioners and committees in skilled nursing facilities in Connecticut.

All skilled nursing facilities (SNFs) in Connecticut were surveyed and more than 71% responded to a Centers for Disease Control-funded project, a component of which is reported herein. The study describes the infection control practitioner (ICP), assistance provided ICPs from external sources, and infection control committees. Almost all ICPs received some training in infection control and worked in the field for an average of 3 1/2 years. Both the number of hours devoted to infection control and the percentage of time spent by the ICP on infection control activities increased with the size of the facility. More than one half of the ICPs in SNFs have relationships with hospital ICPs. The majority of SNF infection control committees met quarterly. The chairperson most often was a physician, although ICPs held this office in almost one third of the reporting SNFs. We conclude that ICPs in Connecticut SNFs have increased in number and that they devote more time and effort to infection control than in previous years.

Aged↗
PubMed1991

Trends in female breast cancer in Connecticut and the United States.

Trends for female breast cancer were examined by age, period and cohort for the years 1950-1984 in U.S. mortality. Connecticut mortality and Connecticut incidence. Birth cohort patterns were evident for all three sets of data. The results confirm a continuing increase in invasive breast cancer by providing evidence of a strong birth cohort pattern, over a time series of 90 years of birth cohorts. This trend appears to be real for the most part because of the cohort patterns and because there is minimal underdetection in data obtained by autopsy and blind biopsy. Secondly, when cohort modeling is applied to breast cancer mortality, there is an indication of a modest decline in recent breast cancer mortality (in the face of an apparent long-term increase), which suggests that control of breast cancer mortality may have developed in recent decades, perhaps through earlier detection and improved treatment. Finally, in contrast with a prior report, there is little evidence for a clinically important difference in time trend between pre- and postmenopausal breast cancer.

Age Factors↗
PubMed2004

Geographic distribution of prostate cancer incidence in the era of PSA testing, Connecticut, 1984 to 1998.

OBJECTIVES: To evaluate the geographic variation of prostate cancer incidence in Connecticut during a 15-year period: before the introduction of prostate-specific antigen (PSA) testing (1984 to 1988), during its introduction (1989 to 1993), and after its widespread adoption (1994 to 1998). METHODS: A spatial scan statistic was used to detect and test the significance of the geographic rate variation among 29,944 incident cases. RESULTS: During 1984 to 1988, eight locations had incidence rates that differed significantly from the statewide level; for 1989 to 1993, only two locations were identified. By 1994 to 1998, a significant rate variation was noted for 10 locations around Connecticut. CONCLUSIONS: The observed geographic variation of incidence rates may reflect differing opportunities to uncover latent cases at given locales.

Adenocarcinoma↗
PubMed2002

Trends in, and predictors of, breast-conserving surgery and radiotherapy for breast cancer in Connecticut, 1988-1997.

PURPOSE: To describe the trends in, and predictors of, use of breast-conserving surgery (BCS) vs. mastectomy and use of post-BCS radiotherapy (RT), from 1988 through 1997 among residents of Connecticut. METHODS AND MATERIALS: Data on surgical and RT procedures for 16,676 women diagnosed with early-stage (localized to the breast or with regional lymph node involvement) invasive breast cancer in 1988-1997 were obtained from the population-based Connecticut Tumor Registry. RESULTS: Use of BCS (vs. mastectomy) increased over time and was lower for patients with nodal involvement or larger tumors. The absence of RT facilities at the hospital of first admission was negatively associated with BCS but not with post-BCS RT. Post-BCS RT was low among patients diagnosed at age 80+ years but increased over time only in this age group. CONCLUSION: Absence of RT at the hospital may be a deterrent to BCS. The temporal increase in post-BCS RT among patients diagnosed at age > or =80 years suggests changes in physicians' attitudes and/or patient preferences that require further study.

Aged↗
PubMed1996

A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction.

BACKGROUND: State-based peer review organizations (PROs) and individual hospitals are challenged to achieve their quality improvement (QI) goals with shrinking resources. In 1993-1994 the Connecticut PRO and 15 local hospitals generated a comparative QI database on acute myocardial infarction (AMI) care for 1,202 Medicare and non-Medicare patients discharged in 1992 and 1993. METHODS: A steering committee composed of hospital and PRO representatives was assembled to provide oversight. PRO staff developed a chart abstraction tool and trained hospital abstractors who collected and submitted data to the PRO for comparative analyses. Written feedback was provided to all hospitals and supplemented with onsite presentations when requested. Each hospital prepared a written QI plan based on its unique data profile. RESULTS: Opportunities for improvement were identified at all hospitals. The most commonly targeted areas for improvement included the use of thrombolytics at presentation, aspirin at presentation and at discharge, and beta blockers at discharge. Improvement interventions included staff education sessions, development of AMI critical paths and standing orders, and storage of appropriate medications in emergency departments. Self-report data from the hospitals indicate improvements in care. DISCUSSION: PROs and hospitals can augment their individual QI activities by working together to share data, resources, and lessons learned. Twenty-three hospitals are now collaborating with the Connecticut PRO on a similarly designed QI project aimed at improving the care of patients hospitalized with atrial fibrillation. This project includes a more formal means of communicating QI interventions.

Aged↗
PubMed2000

Child care health consultation: the Connecticut experience.

OBJECTIVES: The quality of child care is of increasing national concern. Federal initiatives are recommending child care health consultation to promote healthy, safe, and developmentally appropriate care. However, few studies have investigated the implementation of this recommendation. The purpose of this study was to explore the experience of Connecticut child care center directors and their health consultants who were engaged in mandated, weekly, on-site health consultation. METHODS: One hundred Connecticut child care center directors and their health consultants participated in a mailed, self-administered survey. The centers were stratified by region and selected by random probability sampling. Descriptive analyses of the data examined the perspectives of both groups. RESULTS: Eighty-four percent of the child care center directors reported that health consultation visits were important or very important for the management of their programs. Eighty-one percent of the health consultants believed that their directors considered the visits important or very important. The reported tasks of the health consultants were consistent with regulatory requirements. Cost was cited as a factor that negatively influenced access to services by at least 37% of the director sample. Demographics of the sample, description of the role, and recommendations by directors and health consultants are included. CONCLUSIONS: Health consultation visits were highly valued among this sample as an effective means of promoting children's health and development in child care centers. Future initiatives should promote child care health consultation through training, infrastructure development, and funding of health consultation services.

Child↗
PubMed2003

Trends in late-stage breast and cervical cancer incidence rates in Connecticut (United States).

OBJECTIVE: This study examined the temporal trend in late-stage incidence rates for breast and cervical cancer in Connecticut, where a statewide screening program (targeted to poor or uninsured women) began in late 1995. METHODS: Age-standardized incidence rates (ASIRs) for late-stage breast and cervical cancer in Connecticut were analyzed prior to (1988-1991 and 1992-1995) and during (1996-1999) operation of a statewide screening program for lower-income or uninsured women. RESULTS: ASIRs for late-stage cancer declined from the 1988-1991 to 1992-1995, including a reversal in the black-white difference in late-stage breast cancer, while declines from 1992-1995 to 1996-1999 were largely limited to cervical cancer among African American (black) women. CONCLUSIONS: Little progress was evident toward reducing late-stage ASIRs in the 1990s, but continued surveillance is needed to determine if declines in black-white disparities in late-stage cervical cancer ASIRs continue, and to further assess the impact of a statewide screening program.

Adult↗
PubMed2001

Factors associated with home versus institutional death among cancer patients in Connecticut.

OBJECTIVE: To assess the relationships between home death and a set of demographic, disease-related, and health-resource factors among individuals who died of cancer. DESIGN: Prospective cohort study. SETTING: All adult deaths from cancer in Connecticut during 1994. PARTICIPANTS: Six thousand eight hundred and thirteen individuals who met all of the following criteria: died of a cancer-related cause in 1994, had previously been diagnosed with cancer in Connecticut, and were age 18 and older at the time of death. MEASUREMENT: Site of death. RESULTS: Twenty-nine percent of the study sample died at home, 42% died in a hospital, 17% died in a nursing home, and 11% died in an inpatient hospice facility. Multivariate analysis indicated that demographic characteristics (being married, female, white, and residing in a higher income area), disease-related factors (type of cancer, longer survival postdiagnosis), and health-resource factors (greater availability of hospice providers, less availability of hospital beds) were associated with dying at home rather than in a hospital or inpatient hospice. CONCLUSIONS: The implications of this study for clinical practice and health planning are considerable. The findings identify groups (men, unmarried individuals, and those living in lower income areas) at higher risk for institutionalized death-groups that may be targeted for possible interventions to promote home death when home death is preferred by patients and their families. Further, the findings suggest that site of death is influenced by available health-system resources. Thus, if home death is to be supported, the relative availability of hospital beds and hospice providers may be an effective policy tool for promoting home death.

Aged↗
PubMedDate not supplied

Exposure to methyl tertiary-butyl ether from oxygenated gasoline in Stamford, Connecticut.

In 1993, state health officials in Connecticut invited the Centers for Disease Control and Prevention (CDC) to assist in an investigation of exposure to methyl tertiary-butyl ether in oxygenated gasoline in Stamford, Connecticut. Venous blood samples were collected from 14 commuters and from 30 other persons who worked in the vicinity of traffic or automobiles, and the samples were analyzed for methyl tertiary-butyl ether, tertiary-butyl alcohol, benzene, m-/p-xylene, o-xylene, and toluene. The highest levels of methyl tertiary-butyl ether in blood were measured among gasoline service station attendants (median = 15 micrograms/l, range = 7.6-28.9 micrograms/l). Blood levels of methyl tertiary-butyl ether were highly variable among persons who worked in car-repair shops (median = 1.73 micrograms/l, range = 0.17-36.7 micrograms/l) and were generally lowest among commuters (median = 0.11 micrograms/l, range = < 0.05-2.60 micrograms/l). Blood levels of methyl tertiary-butyl ether were correlated strongly with personal-breathing-zone samples of methyl tertiary-butyl ether and blood levels of other volatile organic compounds. This exposure information should prove useful to a future risk analysis of this high-volume chemical.

Air Pollutants↗
PubMed2002

Trends and variability of ground-level O3 in Connecticut over the period 1981-1997.

The temporal and spatial characteristics of ground-level (tropospheric) O3 measured at 10 monitoring stations in Connecticut were studied from 1981 to 1997. To detect the O3 trend caused by changes in precursor emissions, moving average filters and a linear least-squared regression model were used to eliminate the short-term variation and effects of temperature from raw time-series O3 data. The results showed a significant decrease in the number of days exceeding the National Ambient Air Quality Standards (NAAQS) and a small change in total O3 concentration. The analysis indicated that the variation of daily maximum O3, caused by changes in emissions, explained more than 10% of the total O3 variation in Bridgeport and East Hartford during the past 17 years. Meanwhile, a strong weekly cycle was also found in O3 time-series data, resulting in lower O3 concentration in urban areas than in nonurban areas, implying that land use and land cover have impacts on the spatial distribution of ground-level O3 in Connecticut.

Air Pollutants↗
PubMedDate not supplied

Emergency medical services in Connecticut.

This article describes emergency medical services (EMS) systems in Connecticut, beginning with a historical perspective. The discussion of statewide oversight of the EMS system includes legislative and regulatory mandates as well as recent external reviews of the system. Medical oversight of EMS care and services is provided by sponsor hospitals rather than individual medical directors. Most of the 169 cities and towns in the State maintain or contract for local EMS, and have traditionally resisted regionalization. This snapshot of the EMS system in Connecticut can serve as a reference for comparison of EMS systems in other jurisdictions.

Allied Health Personnel↗
PubMed2000

The emergence of another tickborne infection in the 12-town area around Lyme, Connecticut: human granulocytic ehrlichiosis.

Human granulocytic ehrlichiosis (HGE) is an emerging tickborne infection, increasingly recognized in areas in which Lyme disease is endemic, but there are few data on the incidence of HGE. Prospective population-based surveillance was conducted in the 12-town area around Lyme, Connecticut, by means of both active and passive methods, from April through November of 1997, 1998, and 1999. Five hundred thirty-seven residents presenting to their primary care provider with an acute febrile illness suggestive of HGE were identified. Of these, 137 (26%) had laboratory evidence (by indirect fluorescent antibody staining or polymerase chain reaction) of HGE; 89 were confirmed cases, and 48 were probable cases. The incidence of confirmed HGE was 31 cases/100,000 in 1997, 51 cases/100,000 in 1998, and 24 cases/100,000 in 1999. A subset of sera was tested by use of immunoblot assays, and results were in agreement with indirect fluorescent antibody methods for 86% of samples analyzed. Thus, HGE is an important cause of morbidity and is now the second most common tickborne infection in southeastern Connecticut.

Adolescent↗
PubMed2001

Risk factors for human exposure to raccoon rabies during an epizootic in Connecticut.

The emergence of rabies among terrestrial wildlife poses increasing but poorly defined risks to people. In particular, events leading to human exposure to rabies virus via mammalian reservoirs remain elusive. Thus, we determined those risk factors associated with human exposure to rabies-positive animals during a raccoon rabies epizootic in Connecticut. Existing passive surveillance data on animal rabies tests in Connecticut from 1991 through 1994 were evaluated for demographic, ecological, and behavioral characteristics of human exposure. Of 2,525 rabies-positive terrestrial animals identified, human contact was reported on 556 occasions (22%) and involved at least 939 individuals. The annual incidence of exposure rose from none during 1985-1990 to 66 in 1991 and then averaged 291 during 1992-1994. Exposure was most often indirect in nature, involved a rabies-positive raccoon, was mediated through a domestic animal, and occurred most frequently either near or inside the home. These results suggest that human exposure to rabid animals represents a significant, reemerging public health concern in the United States. Analysis of the epizootiology of rabies infection and of individual exposure risks could reduce inappropriate administration of rabies postexposure prophylaxis, as well as inform other proposed interventions.

Animals↗
PubMed2002

Spatiotemporal analysis of epizootic raccoon rabies propagation in Connecticut, 1991-1995.

The quantitative analysis of pathogen transmission within its specific spatial context should improve our ability to predict and control the epizootic spread of that disease. We compared two methods for calibrating the effect of local, spatially distributed environmental heterogeneities on disease spread. Using the time-of-first-appearance of raccoon rabies across the 169 townships in Connecticut, we estimated local spatial variation in township-to-township transmission rate using Trend Surface Analysis (TSA) and then compared these estimates with those based on an earlier probabilistic simulation using the same data. Both the probabilistic simulation and the TSA reveal significant reduction in transmission when local spatial domains are separated by rivers. The probabilistic simulation suggested that township-to-township transmission was reduced sevenfold for townships separated by a river. The global effect of this sevenfold reduction is to increase the time-to-first-appearance in the eastern townships of Connecticut by approximately 29.7% (spread was from west to east). TSA revealed a similar effect of rivers with an overall reduction in rate of local propagation due to rivers of approximately 22%. The 7.7% difference in these two estimates reveals slightly different aspects of the spatial dynamics of this epizootic. Together, these two methods can be used to construct an overall picture of the combined effects of local spatial variation in township-to-township transmission on patterns of local rate of propagation at scales larger than the immediate nearest neighboring townships.

Animals↗
PubMed2005

A population survey of smallpox knowledge, perceptions, and healthcare-seeking behavior surrounding the Iraq invasion--Connecticut 2002-03.

BACKGROUND: Knowledge and perceptions about smallpox would probably influence public behavior following an intentional smallpox release. We assessed public knowledge, perceptions, and related healthcare-seeking behavior in Connecticut during the period of heightened interest in smallpox preparedness surrounding the Iraq invasion. METHODS: Smallpox-related questions were added to Connecticut's Behavioral Risk Factor Surveillance System survey, an ongoing statewide adult population-based survey during December 2002-July 2003 and November-December 2003. RESULTS: Among 4,074 respondents, when asked about a hypothetical febrile illness, 72% would first contact their primary care provider (PCP) on weekdays. During nights and weekends, respondents would depend nearly equally on PCPs and emergency departments (37% versus 36%). Most knew smallpox is transmissible from person to person (72%) but not that the majority infected with smallpox survive (38%) or that smallpox is most contagious after the appearance of rash (11%). Knowledge regarding transmissibility and mortality improved during the study period (p < 0.001). Only 31% recognized that vaccinia vaccine is riskier than routine vaccines; 41% would choose vaccination if available. Concern about smallpox's potential use as a weapon was high but decreased after President Bush declared "mission accomplished" in Iraq in May 2003 (p < 0.001). CONCLUSIONS: Despite national coverage of smallpox by the media, most respondents lacked basic knowledge regarding the disease. Incorrect perceptions regarding vaccinia vaccine's risks could increase inappropriate vaccine demand among nonexposed people with vaccine contraindications during a mass vaccination campaign. Current perceptions should inform future smallpox preparedness planning. In addition, both PCPs and emergency medicine clinicians should be targeted for education regarding smallpox diagnosis.

Adolescent↗