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PubMed1997

Seasonal presentation of keratoacanthomas in Rhode Island.

Seasonal presentation of skin cancers has been previously described, but the seasonal presentation of keratoacanthomas is less well documented. Pathology reports and dermatology clinic visits were examined from the Roger Williams Medical Center, the major dermatopathology service in Rhode Island, U.S.A., from 1990 to 1992. Seasonal presentation was defined as the ratio of keratoacanthomas during the summer months (June-September) to the number diagnosed during the winter months (December-March). A peak incidence of keratoacanthomas was noted in the summer and early autumn months. The summer/winter ratio (1-38) was statistically significant (P = 0.002). The summer/winter ratio of office visits was smaller at 1.12, but also significant (P < 0.001). There appears to be a seasonal presentation of keratoacanthoma in southern New England. This suggests that ultraviolet radiation has an acute effect on the development of keratoacanthoma.

Humans↗
PubMed1980

Socioeconomic forces as determinants of childhood mortality decline in Rhode Island, 1860-1970: a comparison with England and Wales.

The author tests McKeown's hypothesis that socioeconomic improvement was the most important cause of mortality decline in England and Wales. First, McKeown's basic work is replicated using data on childhood mortality in Rhode Island between 1860 and 1970. "Then the effect of socioeconomic change on mortality change is examined in ways that differentiate it from other effects. Next, socioeconomic and public health effects on disease are differentiated by computing case-fatality and incidence rates." The results provide support for McKeown's argument.

Americas↗
PubMed2001

Needle exchange program attendance and injection risk in Providence, Rhode Island.

Needle sharing has long been recognized as a primary route of HIV infection. However, recent research has shown that HIV antibody is also detectable in injection supplies other than needles. In this study we tested frequency of attendance at a Providence, Rhode Island, needle exchange program (NEP) as a correlate of injection risk indicators including not just sharing needles but also sharing cookers, sharing cotton filters, cleaning the skin before injecting, and using bleach as a needle disinfectant. Results showed that drug users who attended the NEP less frequently were more likely to report needle sharing, less likely to report always cleaning their skin, and more likely to report sharing cookers. The Providence NEP is one at which alcohol swabs and cookers are distributed along with clean needles. Our results suggest that NEPs represent a valuable and underexploited opportunity to promote risk reduction efforts beyond the avoidance of needle sharing. NEPs should be distributing risk reduction supplies in addition to clean needles and should adopt strategies (e.g., outreach and more days/hours of operation) to encourage frequent attendance.

Adult↗
PubMedDate not supplied

[The University of Rhode Island Change Assessment Scale (URICA)].

The present paper describes a German version of the University of Rhode Island Change Assessment Scale (URICA) called Fragebogen zu Erfassung der Veränderungsbereitschaft (FEVER). The URICA is a questionnaire designed to measure the stages of change. This instrument is well suited for complex problem behavior, because it yields scores for each stage of change for each individual instead of classifying individuals into a single stage. It is based on Prochaska's transtheoretical model of change. This model recognizes that most psychological disorders are characterized by repetitive problem behaviors that are resistant to modification, and that people do not make a simple black or white decision to change their behavior, rather it holds that people change their behavior gradually across different stages. The model has been successfully applied in different areas of health care to help preventive and treatment interventions adjust to clients' readiness for change. The FEVER was used and tested in a cross-sectional study of 129 patients with an eating disorder. It turned out to be an instrument that was easily understood by patients and that yielded the factor structure of the original version. The internal consistency of the scales was good or very good. Means and standard deviations of the scales were comparable to those found using the original instrument. In addition, there was evidence for the predictive and concordant validity of the instrument. We conclude that the FEVER is a valid instrument to assess the motivational dimension of therapeutic change of complex problem behavior.

Adult↗
PubMedDate not supplied

An analysis of occupational burn injuries in Rhode Island: workers' compensation claims, 1998 to 2002.

Occupational burns have been determined to be a serious public health concern. The analysis of workplace risks and risk factors associated with burns are critical to developing effective interventions in the future. In this study, we examined accepted Rhode Island workers' compensation claims (n = 5619) from 1998 to 2002 to assess the rates and risks of occupational burns. We used employment data from the Department of Labor's Current Population Survey (CPS) to estimate claim rates and shift analyses. The overall burn rate was estimated to be 24.3 per 10,000 workers. The claim rate for workers younger than 25 years of age was almost double that for all other age groups. The average per-claim disability duration for claims requiring indemnity was 167.9 days, and average annual total cost of claims was dollar 1,010,166. The highest claim rate identified was for workers in food service occupations and an increased risk was found for chemical burns among evening and night-shift workers. Increased interventions are needed to reduce occupational burns in work settings. Particular diligence should be should address occupational burn hazards in restaurant establishments, and preventative should be measures aimed at young employees and late-shift workers.

Accidents, Occupational↗
PubMed2006

HIV and HCV testing for young drug users in Rhode Island.

Young injection drug users (IDU) are at risk for both human immunonodeficiency virus (HIV) and Hepatitis C infections (HCV). Rates of HIV testing have been widely documented, but limited information exists regarding HCV screening rates. Among a community sample of 86 IDUs, aged 18-25 years in Rhode Island, 87.2% reported ever testing for HIV versus 51.2% for HCV (p < .001). Young injectors were under-screened for HCV compared with the far less prevalent HIV infection.

Adolescent↗
PubMed1995

Knowledge of and attitudes about adverse drug reaction reporting among Rhode Island pharmacists.

OBJECTIVE: To survey pharmacists' knowledge of the adverse drug reaction (ADR) reporting process, as well as the nature and seriousness of ADRs observed by pharmacists, and to determine how pharmacists perceive their role in monitoring and reporting suspected reactions. DESIGN: A survey was mailed to 793 Rhode Island pharmacists with a 40% (318) response rate. RESULTS: Two hundred and thirty-five surveys were reviewed for final analysis. Pharmacists in retail settings were more likely than hospital pharmacists to be aware of ADRs relating to therapeutic inequivalence and over-the-counter products, and more likely to ask the patient about ADRs (40% vs 16%). Hospital pharmacists were more likely to receive ADR information from physicians (40% vs 15%). Almost all pharmacists (97%) believed that action should be taken when a serious ADR is suspected. Younger pharmacists (< 45 y) were more willing to contact the physician and refer the patient to medical attention. CONCLUSIONS: Our results show that fewer than half of the respondents (41%) claimed to have observed a serious ADR (potentially life-threatening or requiring hospitalization), although almost all (97%) believed that pharmacists should take some action when a serious ADR is suspected. The influence of the practice setting, the number of years in practice, and the number of hours worked per week influenced the reporting practices and attitudes.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

Chronic interstitial lung disease in nylon flocking industry workers--Rhode Island, 1992-1996.

Interstitial lung disease (ILD) occurs infrequently; some cases are attributed to sarcoidosis, pulmonary hemorrhage syndromes, connective tissue diseases, hypersensitivity pneumonitis, drugs, radiation, and mineral dusts (e.g., silica or asbestos). However, most cases of ILD are of uncertain classification or etiology. This report describes preliminary findings of the investigation in Rhode Island of an outbreak of ILD among workers involved in the manufacture of finely cut nylon (flock) and flocked fabric (used for upholstery, clothing, and automobiles); the findings provide evidence of a newly recognized occupational illness.

Adult↗
PubMed2005

Correlates of partner-specific condom use intentions among incarcerated women in Rhode Island.

CONTEXT: Few studies of incarcerated women have examined potential associations between risky sexual behavior and relationship context factors; thus, little is known about the correlates of intentions to use condoms with main and casual partners in this underserved population. METHODS: A sample of 221 women incarcerated in a Rhode Island Department of Corrections facility in 2002-2003 were interviewed. Multiple linear regression analysis was performed to assess associations between selected demographic, psychosocial and behavioral variables and participants' reported intentions to use condoms with main and casual sexual partners in the first six months after their release. RESULTS: Condom use at last sex with a main partner, sexually transmitted disease (STD) history, no strong desire to currently be pregnant, belief that others influence one's health and perceived STD risk were positively associated with women's intention to use condoms with main partners. Pregnancy history was negatively associated with intention to use condoms with a main partner. Condom use at last sex with a casual partner was positively associated with intention to use condoms with casual partners, whereas binge drinking and believing in the role of chance in determining one's health were negatively associated with intention to use condoms with casual partners. CONCLUSIONS: Whether incarcerated women define a partner as main or casual may influence their decisions about the need to protect themselves by using condoms. Programs that focus on the importance of condom use with all partners could greatly benefit incarcerated women and the communities to which they return.

Adult↗
PubMed1994

Tuberculosis during pregnancy. The Rhode Island experience, 1987 to 1991.

Although recent studies have reported otherwise, previous conventional wisdom has held that one-half to two-thirds of pregnant women with tuberculosis are asymptomatic. If true, this has important implications for screening programs. Charts of all patients with culture-proven Mycobacterium tuberculosis in Rhode Island between 1987 and 1991 were reviewed. One-third of women aged 21 to 32 years with culture-proven tuberculosis were pregnant at time of diagnosis (7 pregnant; 15 nonpregnant). Pregnant patients with pulmonary conditions were more likely to be found through routine screening (p = 0.008) and to be asymptomatic (p = 0.008). In addition, pregnant women with pulmonary conditions were more likely to present with unilateral non-cavitary, smear-negative disease (p = 0.02). If routine screening is not performed prenatally with radiographic follow-up of all infected individuals, most pregnant women will not have their conditions diagnosed and, therefore, will not be treated in time to prevent risk to the fetus, the newborn, and the obstetric ward.

Adult↗
PubMed2002

A clinical case for quality. Rhode Island takes the lead in first wave of initiatives seeking consensus on clinical practices as markers for quality care.

Clinical guidelines for treating three common conditions that send people to the hospital are becoming the initial focus of a wave of efforts to reach a consensus on clinical practices as markers for quality. Marcia Petrillo (left) leads Rhode Island's quality-improvement organization. Shown on the cover are Patricia Nolan, seated, state health director, standing from left, Petrillo; Cathy Boni of the state hospital association; and Maureen Maigret of the lieutenant governor's office.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

The impact of diagnosis-related groups on the cost of hospitalization for end-stage renal disease patients at Rhode Island Hospital from 1987 to 1990.

The introduction of diagnosis-related groups (DRGs) for the reimbursement of hospital costs in the Medicare population made no provisions to identify end-stage renal disease (ESRD) patients. To assess the impact of the DRGs on ESRD patients, we prospectively evaluated all hospitalizations (901) at the Rhode Island Hospital from July 1987 through April 1990 among a chronic hemodialysis population of 587 patients. The complied data on length of hospital stay, cost per day, and total cost were compared with the accepted allowances as defined by the DRG codes assigned to the admissions. The mean values and comparisons were length of stay, 10.2 +/- 21 days (ESRD) versus 9.7 +/- 3.6 days (DRGs), P = 0.44; cost per day, $1,240 +/- $685 (ESRD) versus $671 +/- $897 (DRGs), P = 0.0001; and total cost, $9,660 +/- $17,170 (ESRD) versus $6,815 +/- $8,872 (DRGs), P = 0.0001, a difference of $2,275 per admission. The increase in daily, and thus total, costs was primarily due to the use of supplies, medications, laboratory procedures, and transfusion services. It appears from our data that the DRGs do not adequately reflect the cost of caring for ESRD patients with the same DRGs as non-ESRD patients because of increased demand for ancillary services. If these observations are confirmed, a reevaluation of the DRG process as it relates to ESRD patients is warranted.

Diagnosis-Related Groups↗
PubMed2001

Converting day treatment centers to supported employment programs in Rhode Island.

OBJECTIVE: The purpose of the study was to compare vocational and nonvocational outcomes of clients of two community mental health centers that underwent conversion from day treatment programs to supported employment programs with outcomes of clients of a center that delayed conversion until after the study was completed. METHODS: As part of a statewide effort in Rhode Island to convert day treatment programs to supported employment programs, the authors assessed 127 day treatment clients with severe mental illness in three community mental health centers. Two of the centers converted to supported employment, and one continued its rehabilitative day program. Participants were assessed prospectively for 30 to 36 months, with special attention to vocational and social outcomes. RESULTS: Former day treatment clients in the converted centers attained higher rates of competitive employment than those in the comparison group (44.2 percent and 56.7 percent versus 19.5 percent). Other employment outcomes also improved, and hospitalization rates and overall social functioning were unchanged. CONCLUSIONS: This study supports findings of previous studies suggesting that replacing rehabilitative day treatment programs with supported employment programs yields improvements in employment outcomes without adverse effects.

Adolescent↗
PubMed2003

Do-not-resuscitate and stratification-of-care forms in Rhode Island.

Congress passed the Patient Self-Determination Act of 1990 to ensure that patients are informed of their rights to express healthcare preferences in advance of loss of capacity. Thus, a patient may elect to forgo cardiopulmonary resuscitation in favor of a treatment approach that favors comfort over survival. Do-not-resuscitate and stratification-of-care forms provide a means for expression of healthcare preferences in hospitals. These forms can often guide the important discussion of healthcare preferences. Unfortunately, no clear standard exists for what should be included in do-not-resuscitate or stratification-of-care forms that institutions seeking to improve in this vital area of practice could use for guidance. Existing forms in use at adult general hospitals throughout Rhode Island were reviewed.

Adult↗
PubMed1989

Natural history of acquired immunodeficiency syndrome in women in Rhode Island.

PURPOSE: Current recommendations for treatment of human immunodeficiency virus (HIV) infection and for prophylaxis against associated opportunistic infections in North America are largely based on observations of HIV infection in males. In an effort to determine whether the natural history and clinical course may be different, with implications relevant to prophylaxis against opportunistic infections, we have documented the clinical courses of the first 24 known cases of acquired immunodeficiency syndrome (AIDS) in women in Rhode Island, most of whom developed Centers for Disease Control-defined AIDS before the availability of an effective antiviral agent (i.e., zidovudine) or a well-defined approach to prophylaxis against opportunistic infections (e.g., oral trimethoprimsulfa). PATIENTS AND METHODS: The subjects in this study are 24 women with AIDS who were treated by members of the Brown University medical faculty from June 1982 through June 1988. All patients had thorough clinical evaluations and appropriate laboratory studies as they became available. All were followed at intervals no greater than two months. All opportunistic infections were treated by appropriate, specific antimicrobial therapy. When zidovudine became available, it was administered to all remaining patients in the study. All subjects were counseled about HIV infection, its modes of transmission, and the early symptoms of opportunistic infections. RESULTS: These observations yielded the following three major findings: (1) Candida esophagitis was the most common (38%) AIDS-defining event; (2) Pneumocystis carinii pneumonia was less frequently the AIDS-defining event (13%) and occurred less commonly during the illness (29%) than in North American males with AIDS; (3) Of 14 women in whom the diagnosis of AIDS was established before January 1, 1987, the mean survival time after diagnosis was greater than 20 months. CONCLUSION: More information on the natural history of HIV infection in North American women is urgently needed. If more extensive data from other geographic regions confirm the observations in this study, the optimal approach to prophylaxis against opportunistic infections in women with AIDS may be substantially different from that which is most appropriate for males.

Acquired Immunodeficiency Syndrome↗