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At least 1,693 records · Page 94Linked to original sources
PubMed1984

Cancer incidence among cosmetologists.

This cohort study examined cancer incidence in 13,650 Connecticut cosmetologists who had held licenses for 5 years or more and had begun hairdressing school prior to January 1, 1966. Cancer incidence rates for the general Connecticut population, 1935-78, were compared with those for 11,845 female and 1,805 male cosmetologists. The females had a standardized cancer incidence ratio (SIR) of 112 (P less than .01). A significant excess of lung cancer (SIR = 141) and excesses of brain (SIR = 168) and ovarian cancer (SIR = 134) of borderline significance were observed. No significant cancer risk was evident for female cosmetologists licensed since 1935, even for those with 35 years or more of follow-up, although the SIRs for brain cancer, lymphoma, and leukemia were elevated. Female cosmetologists who entered the profession between 1925 and 1934, however, experienced a significant overall cancer incidence (SIR = 129) and significant excesses of respiratory, breast, corpus uterine, and ovarian cancers. Those with 35 years or more from time of first license appeared to be at the highest risk. Among males the overall cancer incidence rate was close to that expected (SIR = 105). Smoking habits and reproductive factors that could not be taken into account may explain some of the excesses among females. Although no specific occupational agent could be identified, the excess numbers of leukemias in females and brain cancers among males and females merit continued surveillance.

Adult↗
PubMed1982

Second cancers following radiotherapy for cervical cancer.

Incidence of second primary cancers was evaluated in 7,127 women with invasive cancer of the cervix uteri, diagnosed between 1935 and 1978, and followed up to 38 years (average, 8.9 yr) in Connecticut. Among 5,997 women treated with radiation, 449 developed second primary cancers compared with 313 expected (relative risk = 1.4) on the basis of rates from the Connecticut Tumor Registry. Excess incidence was noticeable 15 years or more after radiotherapy and attributed mostly to cancers of sites in or near the radiation field, especially the bladder, kidneys, rectum, corpus uteri, and ovaries. No excess was found for these sites among the 1,130 nonirradiated women. The ratio of observed to expected cancers for these sites did not vary appreciably by age at irradiation. The data suggested that high-dose pelvic irradiation was associated with increase in cancers of the bladder, kidneys, rectum, ovaries, corpus uteri, and non-Hodgkin's lymphoma but, apparently, not leukemia, Hodgkin's disease, breast cancer, or colon cancer.

Adult↗
PubMed1982

Adenocarcinoma of the small bowel. Clinical features, similarity to regional enteritis, and analysis of 338 documented cases.

A case of ileal adenocarcinoma is presented and the clinical features of adenocarcinoma of the small bowel are discussed. Special attention is paid to the differentiation of this tumor from Crohn's disease. Analysis of Connecticut Tumor Registry data on 338 cases of small intestinal adenocarcinoma occurring between 1935 and 1978 reveals a predilection for the elderly but no sex predominance (male/female = 0.965). Two hundred fifty-four patients were followed for at least 5 yr, and the overall (1935-1978) 5-yr survival rate was 17.3%. No improvement in survival has taken place in Connecticut over the past 40 yr.

Adenocarcinoma↗
PubMedDate not supplied

Long-term survival among men with conservatively treated localized prostate cancer.

OBJECTIVE: To determine age-specific, all-cause mortality, disease-specific mortality, and life expectancy for men aged 65 to 75 years who are treated only with immediate or delayed hormonal therapy for newly diagnosed, clinically localized prostate cancer. DESIGN: A population-based, retrospective cohort study. SETTING: Patient records were abstracted from 37 acute care hospitals and two Veterans Affairs medical centers in Connecticut. Original pathology slides were sent to a referee pathologist who was blinded to case outcomes. SUBJECTS: All men identified by the Connecticut Tumor Registry with clinically localized prostate cancer diagnosed in 1971 to 1976 who were aged 65 to 75 years at the time of diagnosis and were untreated or treated with immediate or delayed hormonal therapy. MAIN OUTCOME MEASURES: Parametric proportional hazards models incorporating tumor histologic findings, comorbidity, and age at the time of diagnosis to compare cohort survival with that of men in the general population. RESULTS: After a mean follow-up of 15.5 years, the age-adjusted survival for men with Gleason score 2 to 4 tumors was not significantly different from that of the general population. Maximum estimated lost life expectancy for men with Gleason score 5 to 7 tumors was 4 to 5 years and for men with Gleason score 8 to 10 tumors was 6 to 8 years. Tumor histologic findings and patient comorbidities were powerful independent predictors of survival. CONCLUSIONS: Compared with the general population, men aged 65 to 75 years with conservatively treated low-grade prostate cancer incur no loss of life expectancy. Men with higher-grade tumors (Gleason scores 5 to 10) experience a progressively increasing loss of life expectancy. Case series reports of survival/mortality experienced by men with clinically localized prostate cancer that fail to control for age, tumor histologic features, and comorbidities risk significant bias.

Aged↗
PubMed1994

Gynecologic surveillance of women on tamoxifen.

PURPOSE: To determine the gynecologic surveillance practices of Connecticut physicians regarding asymptomatic, postmenopausal women receiving tamoxifen for breast cancer management prior to and following a National Cancer Institute (NCI) directive recommending ongoing study and annual pelvic examinations. MATERIALS AND METHODS: An anonymous survey of 110 Connecticut medical oncologists, and 306 gynecologists was completed. RESULTS: Sixty-three of 110 (57.3%) medical oncologists and 134 of 306 (43.8%) gynecologists responded to the survey. Prior to the NCI directive, 51 (81.0%) of the medical oncologists referred patients for annual gynecologic surveillance. A pelvic examination and Papanicolaou smear were anticipated. Following the NCI directive, 29 (46.0%) routinely expected an endometrial biopsy and 17 (27.0%) expected a pelvic ultrasound evaluation. Prior to the directive, 96 (71.6%) gynecologists recommended annual gynecologic surveillance and 35 (26.1%) recommended it semiannually. Following the directive, semiannual evaluation was recommended by 52 (38.8%). Prior to the directive, 11 gynecologists (8.2%) recommended annual endometrial biopsies and 21 (15.7%) pelvic ultrasound examinations. Following the directive these recommendations increased to 24.6% and 59.7% respectively. If the endometrium was 5-8 mm in maximum thickness by ultrasound evaluation, 54.4% of gynecologists recommended endometrial sampling. CONCLUSION: Women receiving tamoxifen are now undergoing increased gynecologic surveillance. A rationale for annual evaluation of asymptomatic postmenopausal patients based on endometrial thickening by ultrasound examination is presented.

Breast Neoplasms↗
PubMed1994

The effect of misdiagnosis and delay in diagnosis on clinical outcome in melanomas of the foot.

BACKGROUND: Melanoma of the foot is often discussed as an uncommon tumor which, when it occurs, presents in nonwhite races. STUDY DESIGN: The tumor registry of a 650 bed community teaching hospital and the Connecticut Tumor Registry were retrospectively reviewed for the nine-year period from July 1980 to July 1989. Patient age, race, sex, incidence of misdiagnosis, and delay until definitive therapy were recorded. Tumor location, size, staging, follow-up, recurrence, and disease-free survival rates were also recorded and correlated with initial disease, stage, and misdiagnosis or delay. RESULTS: Twenty-six cases were identified at Bridgeport Hospital, and 140 cases were identified in the Connecticut Tumor Registry. Significant delay in diagnosis occurred in 68 percent of the cases from the hospital and at least 16 percent of the cases in the state tumor registry. Regardless of stage, melanoma of the foot had a worse prognosis than melanoma of the thigh and lower leg. Delays in diagnosis had no demonstrable effect on clinical outcome. CONCLUSIONS: Melanoma of the foot is not as rare as commonly suspected, and constituted 3 percent of the 4,562 melanomas reported in the state tumor registry for the nine-year period. The majority were in fair-skinned individuals, and misdiagnosis was common. It is the inherent aggressiveness of the tumor rather than the delay in diagnosis that accounts for the poor clinical outcome.

Diagnostic Errors↗
PubMed1993

Advanced practice: a model for neonatal/perinatal and women/child nursing.

Collaboration between service and academia has often been disparate. A new model of cooperation was designed in the Fall of 1992 by faculty at the University of Connecticut School of Nursing and nurse administrators at John Dempsey Hospital of the University of Connecticut Health Center. A combined effort was undertaken to expeditiously prepare, at the graduate level, acute care nurse practitioners in Critical Care and Neonatal/Perinatal Nursing. The impetus for the collaborative effort was due in part to: reduced medical residency hours for patient coverage; limited access by patients to care in teaching hospitals because of demands in practice and academic roles; the need to bridge the gap between nursing and medicine; and fragmentation of care. The premise underlying all teaching, learning, and evaluation in the program is androgogy, or the art and science of helping adults learn. The program meets the current National Certification Corporation requirements for certification eligibility. A new evaluation instrument, the Learning Assessment Resource Scale (LARS) was designed by operationalizing Benner's seven domains of nursing practice. The Learning Assessment Resource Scale is based on the premise that expert nursing care is holistic rather than procedural. As an outcome of the collaboration between service and academe, there is enhanced mutual respect, the care-cure dichotomy has been bridged, and advanced practice nurses are educationally prepared to give expert care.

Certification↗
PubMed1981

Legal rights and involuntary transfer following voluntary admission.

Despite careful screening, community mental health centers occasionally admit to their inpatient units patients who prove difficult to manage and who require treatment in a more restrictive setting, or they admit patients who, by the nature of their pathology, require treatment in a long-term facility. It is not unusual for such patients, who have entered treatment voluntarily, to be transferred to other facilities on involuntary status under an emergency certificate and without benefit of a probate court hearing. In a study at the Connecticut Mental Health Center, the authors found that only a small percentage of the population (3.5 per cent) was involuntarily transferred. However, all the patients had entered treatment voluntarily, and in no case was the transfer made after a court hearing. The authors consider the question of whether routinely bypassing probate court hearings in making such transfers is an infringement of the patients' civil rights.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Gram-positive rod surveillance for early anthrax detection.

Connecticut established telephone-based gram-positive rod (GPR) reporting primarily to detect inhalational anthrax cases more quickly. From March to December 2003, annualized incidence of blood isolates was 21.3/100,000 persons; reports included 293 Corynebacterium spp., 193 Bacillus spp., 73 Clostridium spp., 26 Lactobacillus spp., and 49 other genera. Around-the-clock GPR reporting has described GPR epidemiology and enhanced rapid communication with clinical laboratories.

Anthrax↗
PubMed2004

Mohs micrographic surgery vs traditional surgical excision: a cost comparison analysis.

OBJECTIVE: To compare the cost and margin adequacy of Mohs micrographic surgery (Mohs) and traditional surgical excision (TSE) for the treatment of facial and auricular nonmelanoma skin cancer (NMSC). DESIGN: Prospective cost analysis with each patient serving as his or her own control. SETTING: Study was performed from 1999 to 2001 at the University of Connecticut dermatology clinic, a tertiary care referral center. PATIENTS: A total of 98 consecutive patients with a primary diagnosis of NMSC on the face and ears. MAIN OUTCOME MEASURES: The average cost of Mohs and TSE per patient for the treatment and repair of NMSC; adequacy of TSE margins after the initial procedure(because this outcome affects overall cost). RESULTS: Mohs was cost comparable to TSE when the subsequent procedure for inadequate TSE margins after permanent section was Mohs (937 vs 1029 US dollars; P =.16) or a subsequent TSE (937 vs 944 US dollars; P =.53). When facility-based frozen sections were requested for TSE, Mohs was significantly less costly (956 vs 1399 US dollars; P<.001). The cost difference between Mohs and TSE was sensitive to the type of repair chosen. CONCLUSIONS: If the end point is clear margins, Mohs is cost comparable to TSE performed by otolaryngologic surgeons. Some caution is needed when evaluating the cost of facial and auricular NMSC treatment because the choice of repair can significantly affect the cost conclusions.

Aged↗
PubMedDate not supplied

Cancer early-detection services in community health centers for the underserved. A randomized controlled trial.

BACKGROUND: Achieving cancer early-detection goals remains a challenge, especially among low-income and minority populations. DESIGN/SETTING: A randomized trial based in 62 community health centers for the underserved in New York, New Jersey, and western Connecticut. Family physicians were on staff at most of the centers. INTERVENTION: Workshops, materials, and ongoing advice for center leaders promoted implementation of a preventive services office system to identify patients in need of services at each visit through use of medical record flow sheets, other tools, and staff involvement. EVALUATION END POINTS: The proportion of randomly selected patients by center who were up to date for indicated services at baseline (n = 2645) and follow-up (n = 2864) record review. RESULTS: Only 1 service (breast self-examination advice) increased more in intervention centers. Seven of 8 target services increased significantly for the 62 centers overall. During the study, the medical director changed in 26 centers (42%). Keeping the same medical director at intervention centers was associated with improvements in services. CONCLUSIONS: Cancer early-detection services are improving in community health centers, but the intervention had only a small impact, as determined by record review. To have an impact, the intervention required that there be no change in medical director. The relationship of changes in the practice environment to services delivered is complex and deserves more study.

Aged↗
PubMedDate not supplied

The patient self-determination act and advance directive completion in nursing homes.

OBJECTIVES: To assess the prevalence of advance directives among nursing home residents before and after passage of the Patient Self-Determination Act (PSDA) and to identify factors associated with advance directive completion. DESIGN: Prestudy and poststudy nursing home admissions using medical record reviews and a companion cross-sectional survey of alert and oriented residents. SETTING: Six nursing homes in Connecticut. PARTICIPANTS: Residents (N = 635) from 6 randomly chosen nursing homes in the greater Hartford and greater New Haven areas. MAIN OUTCOME MEASURES: The existence of a documented advance directive, the timing of advance directive completion, and reported reasons for completion and noncompletion. RESULTS: The prevalence of advance directives documentation in nursing home medical records has increased significantly since the implementation of the PSDA (4.7% [14/300] before vs 34.7% [104/300] after PSDA; odds ratio, 10.84; P < .001). The increase in documented advance directives was significant after controlling for sociodemographic and health status factors (odds ratio, 11.5; P < .001). Residents admitted to the nursing homes from hospitals (vs from their home or other source), residents with more education, and residents paying privately for nursing home care (vs using Medicare or Medicaid benefits) were more likely to have documented advance directives. Younger residents (aged < 75 years) were less likely than older residents to have completed a directive. Among the 35 interviewed residents, the most common reason for completing an advance directive was experience with a prolonged death of a friend or family member. Only 1 of the interviewed residents reported that the information provided under the PSDA at the time of admission was an important factor in choosing to complete an advance directive. CONCLUSIONS: Nearly 35% of the residents in the post PSDA cohort had an advance directive documented in the medical record. Most residents with advance directives had completed them more than 6 months before the nursing home admission. The major effect of the PSDA for nursing homes has been to enhance the documentation of existing advance directives. Little evidence exists that providing advance directive information at the time of nursing home admission has enhanced the completion of an advance directive after admission.

Advance Care Planning↗
PubMed2000

Recurrent binge eating in black American women.

CONTEXT: Recurrent binge eating is a core diagnostic feature of bulimia nervosa and binge eating disorder, and in samples of white women has been associated with obesity and psychiatric symptoms. Eating disorders have been believed to occur primarily among white women; in fact, the limited preliminary data available suggest that black women may be as likely as white women to report binge eating. OBJECTIVE: To examine race differences in prevalence of behavioral symptoms of eating disorders and clinically significant recurrent binge eating. DESIGN: Community survey. SETTING: General community in Connecticut and Boston, Mass. PARTICIPANTS: A community sample of 1628 black women and 5741 white women (mean age, 29.7 years) participated in a telephone survey designed to ascertain the presence, during the preceding 3 months, of binge eating and extreme weight control behaviors (vomiting, laxative or diuretic abuse, or fasting). MAIN OUTCOME MEASURE: Interviewer-based phone assessment of recurrent binge eating and behavioral symptoms of eating disorders. RESULTS: Black women were as likely as white women to report binge eating or vomiting during the preceding 3 months, and were more likely to report fasting and the abuse of laxatives or diuretics. Recurrent binge eating was more common among black women than among white women. In both race groups, recurrent binge eating was associated with elevated body weight and increased psychiatric symptoms. CONCLUSION: Results suggest that recurrent binge eating is a significant problem among black and white women. Health professionals need to be ready to respond to this health risk behavior.

Adult↗
PubMed1998

Sex differences in mortality after myocardial infarction: evidence for a sex-age interaction.

BACKGROUND: Studies of sex differences in mortality after myocardial infarction (MI) have shown conflicting results. OBJECTIVES: To test the hypothesis that sex differences in mortality after MI vary according to patients' age, with younger women, but not older women, having a higher mortality compared with men. METHODS: We performed a retrospective cohort study of 1025 consecutive patients who met accepted criteria for MI in 1992 and 1993 in 15 Connecticut hospitals. Data for the study were abstracted from medical records. RESULTS: Women had a 40% higher hospital mortality rate than men. Simple age adjustment eliminated the sex difference in mortality rate (odds ratio, 0.99; 95% confidence interval, 0.66-1.48). However, when the sample was subdivided into 2 age groups, women younger than 75 years showed twice as high a mortality rate as men in the same age group, while among older patients no difference in mortality was found. In multivariate analyses the interaction of sex with age was highly significant, even after adjusting for comorbid conditions, clinical severity, process of care, and hospital characteristics. In the fully adjusted model, this interaction indicated that among patients younger than 75 years women had 49% higher odds of hospital death than men, while in the age group 75 years or older women had 46% lower odds of death compared with men. CONCLUSIONS: A higher mortality of women compared with men after MI is confined to the younger age groups. The sex-age interaction should be considered when examining sex differences in mortality after MI.

Age Factors↗
PubMedDate not supplied

Temporal trends in outcomes of older patients with pneumonia.

BACKGROUND: It is unclear how outcomes of care for patients hospitalized for pneumonia have changed as patterns of health care delivery have changed during the 1990s. This study was performed to determine trends in outcomes of care for older patients hospitalized for pneumonia. METHODS: This retrospective analysis was based on Medicare claims and included most patients with pneumonia who were older than 65 years and admitted to acute care hospitals in Connecticut between October 1, 1991, and September 30, 1997 (fiscal years 1992-1997). We assessed the trends in hospital costs, discharge destination, hospital mortality rates, mortality rates within 30 days of discharge, and 30-day readmission rates for pneumonia. Multivariate logistic regression analyses were used to adjust for differences in patient characteristics. RESULTS: The mean (+/- SD) length of stay declined from 11.9 + 11.4 days to 7.7 + 7.2 days between 1992 and 1997. During this period, adjusted in-hospital mortality rates declined (P =.02), while the adjusted risk of discharge to a nursing facility increased (P<.001) and the adjusted risk of hospital readmission for pneumonia within 30 days of discharge increased (P =.05). The adjusted risk of death 30 days after discharge increased, although the difference was not statistically significant (P =.09). CONCLUSIONS: Between 1992 and 1997, the adjusted risks of mortality after discharge, placement in a nursing facility, and hospital readmission for pneumonia increased among older patients hospitalized for pneumonia, in association with a decline in mean hospital length of stay. These findings raise the question of whether the declining hospital length of stay has negatively affected patient outcomes. Arch Intern Med. 2000;160:3385-3391.

Aged↗
PubMed2001

Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting.

BACKGROUND: Evidence-based clinical practice guidelines recommend the use of warfarin sodium for stroke prevention in most patients with atrial fibrillation (AF) who do not have risk factors for hemorrhagic complications, irrespective of age. METHODS: The medical records of all residents of a convenience sample of long-term care facilities in Connecticut (n = 21) were reviewed. The percentages of all patients with AF (AF patients) and ideal candidates for warfarin therapy (ie, AF patients with no risk factors for hemorrhage) who received warfarin were determined; for patients receiving warfarin, the percentage of days spent in the therapeutic range of international normalized ratio (INR) values (2.0-3.0) was also assessed. The relationship between receipt of warfarin and the presence of stroke and bleeding risk factors was assessed in multivariate models. RESULTS: Atrial fibrillation was present in 429 (17%) of the 2587 long-term care residents. Overall, 42% of AF patients were receiving warfarin. However, only 44 (53%) of 83 ideal candidates were receiving this therapy. In residents who received warfarin therapy, the therapeutic range of INR values was maintained only 51% of the time. The odds of receiving warfarin in the study sample decreased with increasing number of risk factors for bleeding and increased (nonsignificant trend) with increasing number of stroke risk factors present. CONCLUSIONS: Atrial fibrillation is very common among residents of long-term care facilities. Even among apparently ideal candidates, warfarin therapy is underused for stroke prevention in patients with AF. Prescribing decisions and monitoring related to warfarin therapy in the long-term care setting warrant improvement.

Aged↗
PubMed2001

Aspirin and the treatment of heart failure in the elderly.

OBJECTIVES: We sought (1) to determine how often aspirin is prescribed as a discharge medication among patients 65 years or older and hospitalized with both heart failure and coronary artery disease; (2) to identify patient characteristics associated with the decision to prescribe aspirin; and (3) to evaluate the association between aspirin prescription at discharge and 1-year survival. METHODS: We performed a retrospective cohort study of consecutive Medicare beneficiary survivors of a hospitalization for heart failure at 18 Connecticut hospitals (up to 200 hospitalizations per hospital) from 1994 to 1995. RESULTS: Among the 1110 patients in the study sample who did not have a contraindication to aspirin, aspirin therapy was prescribed for 456 (41%) at discharge. Patients who were prescribed aspirin at discharge had a lower 1-year mortality after discharge than patients who were not prescribed aspirin (odds ratio, 0.71; 95% confidence interval, 0.54-0.94), even after adjustment for baseline differences in demographic, clinical, and treatment characteristics between the 2 groups. CONCLUSIONS: This study has identified a strong association between the use of aspirin and lower mortality in older patients with both heart failure and coronary artery disease. The benefit of aspirin is consistent with that expected from randomized trials of other groups of patients with vascular disease.

Age Factors↗
PubMed2002

Missed opportunities for prevention of osteoporotic fracture.

BACKGROUND: Osteoporotic fracture is a growing public health problem burden to society. Despite the importance of physician practices in preventing it, relatively little is known about the osteoporosis-related practices of US physicians. METHODS: A total of 1500 female members of a Connecticut independent practice association model health plan (aged 40-69 years) were surveyed to identify women's receipt of osteoporosis-related services (eg, prevention counseling, bone mineral density [BMD] testing, and communication about treatment options). These findings were compared with recommendations of the US Preventive Services Task Force and the National Osteoporosis Foundation. We received 1007 completed questionnaires, for a response rate of 69%. RESULTS: Only 49% of the sample reported that a health care provider ever discussed osteoporosis with them. In multivariate analyses, women with multiple risk factors were not more likely than other women to have been counseled about osteoporosis and its prevention, although those with an osteopenia/osteoporosis diagnosis were. In contrast to National Osteoporosis Foundation recommendations, only a small minority of high-risk women (12%-34%) had their BMD tested. Although most women with an osteopenia/osteoporosis diagnosis reported receiving information on estrogen replacement therapy, calcium, and weight-bearing exercise, fewer reported receiving information on pharmaceutical alternatives to estrogen (33%) and vitamin D (20%). CONCLUSIONS: The main trigger to physician counseling of women about osteoporosis and its prevention is an osteopenia/osteoporosis diagnosis. Women with multiple risk factors for osteoporosis are not being identified for preventive counseling interventions or BMD testing.

Adult↗