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At least 1,711 records · Page 95Linked to original sources
PubMed2003

Blood exposures and hepatitis C virus infections among emergency responders.

BACKGROUND: Blood exposures in the workplace may put first responders, a group which includes firefighters, emergency medical technicians, and paramedics, at increased risk for hepatitis C virus (HCV) infection. To determine the prevalence of antibody to HCV (anti-HCV) and risk factors for infection among first responders, we analyzed data from prevalence surveys conducted among first responders in Atlanta, Ga, in 1991; Connecticut in 1992; and Philadelphia, Pa, in 1999. METHODS: Serum or blood samples from participants of the 3 surveys were tested for anti-HCV. Prevalence of anti-HCV was compared with that in the general US population and among participants by occupational (Atlanta) and nonoccupational (Atlanta and Philadelphia) risk factors for infection. RESULTS: Prevalence of anti-HCV among the 2946 participants of the 3 surveys ranged from 1.3% to 3.6% and was no different than among appropriate referent groups in the general US population. First responders in Atlanta reported high rates of skin exposures to blood (174 per 100 person-years) but few mucosal or needle-stick exposures (1 and 0 per 100 person-years, respectively) during the 6 months prior to the survey. Hepatitis C virus infection was not associated with a history of skin exposures to blood (prevalence ratio [PR], 1.1; 95% confidence interval [CI], 0.3-4.2), and HCV prevalence did not increase with longer duration (>10 years) of employment (PR, 1.1; 95% CI, 0.3-4.3). Nonoccupational risk factors associated with HCV infection included history of a sexually transmitted disease (PR, 7.4; 95% CI, 1.6-35.3) among Atlanta participants and histories of illegal drug use (PR, 4.4; 95% CI, 2.6-7.2) and blood transfusion before 1992 (PR, 1.9; 95% CI, 1.1-3.3) among Philadelphia participants. CONCLUSIONS: First responders are exposed to blood in the workplace, and standard precautions should be rigorously implemented. Although risk for HCV infection related to percutaneous or mucosal exposures could not be accurately assessed, the low prevalence of HCV infection indicates that routine HCV testing of first responders as an occupational group is not warranted. Testing should routinely be offered to those requiring postexposure management and those with a history of nonoccupational risk factors indicating an increased risk for infection.

Adolescent↗
PubMed1989

Epidemiology of a cluster of Henoch-Schönlein purpura.

We investigated a case cluster of Henoch-Schönlein purpura that occurred in Connecticut during the fall and winter of 1987-1988. In Hartford County, where the case finding was most complete, 16 children were identified with disease onset during the 7-month cluster period (incidence, 1.7 cases per 10,000 children per year) compared with only 3 children with disease onset during the preceding 7 months. The incidence in Hartford County was higher among urban (4.8/10,000) and Hispanic (8.6/10,000) children and children in lower socioeconomic groups (6.9/10,000) than among suburban children or children in higher socioeconomic or different racial groups (0.9 to 1.1 per 10,000). We performed a case-control study involving 14 of the 16 case children from Hartford County, 10 case children from nearby areas, and 47 control children matched to the case children by age and race. Case children were more likely than control children to have had a sore throat during the month before the onset of Henoch-Schönlein purpura (52% vs 22%; odds ratio, 3.8; 95% confidence interval, 1.1 to 13). This difference and other smaller differences between case and control children suggest that the cluster may have been caused by person-to-person spread of an infectious agent of the respiratory tract to susceptible hosts. To our knowledge this is the first report of a cluster of Henoch-Schönlein purpura, and it provides clues for a better understanding of the etiology and epidemiology of the disease.

Antibodies, Bacterial↗
PubMed1996

The preparedness of pediatricians for emergencies in the office. What is broken, should we care, and how can we fix it?

OBJECTIVES: To determine the frequency of emergencies in pediatric practices, assess office emergency preparedness, and explore practitioner's reasons for levels of preparedness. DESIGN AND SETTING: Telephone survey of pediatric offices in Fairfield County, Connecticut. SAMPLE: Fifty-one (98%) of 52 offices participated, representing 481 staff. RESULTS: More than 2400 emergencies are seen each year in the pediatric offices, with a median of 24 emergencies per practice annually. Forty-two (82%) of the practices averaged at least one emergency per month, 13 (25%) experienced more than 50 emergencies annually, and seven (14%) experienced more than 100 emergencies annually. Of all eligible staff, 14% were certified in basic life support and 17% in pediatric advanced life support. The following emergency equipment was missing from offices: oxygen, 14 (27%); intravenous catheters, 14 (27%); bag-valve-mask, 15 (29%); nebulizers, 17 (33%); epinephrine 1:10 000, 27 (53%); and intravenous fluids, 28 (55%). Thirty-seven (73%) of offices had the minimum recommended equipment and training for status asthmaticus management; only 17 (33%) of offices had similar preparation for each of the six other emergencies. High-level emergency preparedness was rare. The perceptions of office pediatricians are that office emergencies are rare, and emergency preparedness is difficult to achieve because practices are too busy and the expense and time commitment are too great. CONCLUSIONS: Emergencies are common in pediatric practices, but problems in the emergency preparedness of practices persist despite previous studies with similar findings, and publication of guidelines. Perceptions of practitioners suggest that not enough effort has been devoted to increasing practitioner awareness of these problems. Greater awareness might result by emphasizing practical instruction in residency and continuing medical education courses, and by publication of guideline summaries.

Adolescent↗
PubMed1975

Utilization of mental health services. I. Patienthood and the prevalence of symptomatology in the community.

We explored the association between patienthood and prevalence of symptomatology in the community. Base line data on prevalence were obtained through the use of a household survey. Characteristics of survey respondents (N equals 938) and patients admitted from the surveyed area to a Connecticut Mental Health Center during a 12-month period (N equals 808) were compared. High utilization of facilities was associated with the prevalence of symptoms in the community, particularly where defining characteristics were descriptors of disadvantaged social status. A second set of variables correlated with mental health center use but not with the prevalence of symptoms in the community. By and large, these characteristics describe a lack of social supports not necessarily related to social status. Finally, certain groups were underrepresented as patients even though comprising polulations-at-risk in terms of levels of symptom impairment in the community.

Adult↗
PubMed1993

Identifying risk factors for tardive dyskinesia among long-term outpatients maintained with neuroleptic medications. Results of the Yale Tardive Dyskinesia Study.

OBJECTIVES: To describe the incidence of tardive dyskinesia (TD) in the Yale TD Study and to identify demographic, treatment, and clinical risk factors for TD occurrence. DESIGN: An ongoing prospective cohort study in which subjects have been examined every 6 months since 1985. SETTING: The outpatient division of the Connecticut Mental Health Center in New Haven. SUBJECTS: Three hundred ninety-eight adult outpatients who had been maintained with neuroleptics for 3 months to 33 years at intake and who were free of persistent TD at intake with no history of persistent TD movements. OUTCOME MEASURE: New cases of persistent TD were defined as the presence of mild or more severe dyskinetic movements at two successive follow-up visits, using the Abnormal Involuntary Movement Scale. RESULTS: As of July 1, 1990, there were 62 new persistent cases of TD, yielding an average incidence rate of 0.053 per year and a 5-year risk of 20%. The TD rate was positively affected by age, being nonwhite, and neuroleptic dose, and it was inversely affected by years of previous exposure. Little or no effects were found for age at first neuroleptic exposure, type of neuroleptic, use of other psychiatric medications, and psychiatric diagnosis. CONCLUSIONS: For outpatients maintained for many years with neuroleptics, dose should be minimized to reduce the risk of TD. This strategy does not appear to be negated by prescribing frequent changes in dosage. Although the TD rate is greatest during the first 5 years of neuroleptic treatment, new persistent cases continue to occur many years after first exposure.

Adult↗
PubMed2000

Cost-effectiveness of clozapine compared with conventional antipsychotic medication for patients in state hospitals.

BACKGROUND: An open-label, randomized controlled trial compared clozapine with physicians'-choice medications among long-term state hospital inpatients in Connecticut. The goal was to examine clozapine's cost-effectiveness in routine practice for people experiencing lengthy hospitalizations. METHODS: Long-stay patients with schizophrenia in a state hospital were randomly assigned to begin open-label clozapine (n = 138) or to continue receiving conventional antipsychotic medications (n = 89). We interviewed study participants every 4 months for 2 years to assess psychiatric symptoms and functional status, and we collected continuous measures of prescribed medications, service utilization, and other costs. We used both parametric and nonparametric techniques to examine changes in cost and parametric analyses to examine changes in effectiveness. We used bootstrap techniques to estimate incremental cost-effectiveness ratios and create cost-effectiveness acceptability curves. RESULTS: Both groups incurred similar costs during the 2-year study period, with a trend for clozapine to be less costly than usual care in the second study year. Clozapine was more effective than usual care on many but not all measures. With the use of effectiveness measures that favored clozapine (extrapyramidal side effects, disruptiveness), bootstrap techniques indicated that, even when a payer is unwilling to incur any additional cost for gains in effectiveness, the probability that clozapine is more cost-effective than usual care is at least 0.80. These findings were not as evident when outcomes where clozapine was not clearly superior (psychotic symptoms, weight gain) were examined. CONCLUSION: Clozapine demonstrated cost-effectiveness on some but not all measures of effectiveness when the alternative was a range of conventional antipsychotic medications.

Adult↗
PubMed1992

Preliminary assessment of a scientific curriculum in a surgical residency program.

A structured, basic science curriculum was instituted for surgical residents of the University of Connecticut (Farmington) Integrated Residency Program during the 1990-1991 academic year in concordance with American Board of Surgery guidelines. The impact of the new program was measured by comparing performance on monthly basic science examinations, the in-training examination, and "mock" oral examinations for the 1990-1991 academic year with that of the preceding academic year. While monthly examination scores improved for the entire group of residents (67.7 vs 64.6), in-training and oral examination scores did not change significantly. Categorical residents generally demonstrated superior performance and greater improvement than did preliminary residents. Data analysis suggested that the new curriculum was an effective educational device and that university-designed monthly examinations were valid testing instruments, but there was an apparent incongruity between the goals of the curriculum and the American Board of Surgery In-Training Examination.

Attitude↗
PubMed1998

Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project.

CONTEXT: Medicare has a legislative mandate for quality assurance, but the effectiveness of its population-based quality improvement programs has been difficult to establish. OBJECTIVE: To improve the quality of care for Medicare patients with acute myocardial infarction. DESIGN: Quality improvement project with baseline measurement, feedback, remeasurement, and comparison samples. SETTING: All acute care hospitals in the United States. PATIENTS: Preintervention and postintervention samples included all Medicare patients in Alabama, Connecticut, Iowa, and Wisconsin discharged with principal diagnoses of acute myocardial infarctions during 2 periods, June 1992 through December 1992 and August 1995 through November 1995. Indicator comparisons were made with a random sample of Medicare patients in the rest of the nation discharged with acute myocardial infarctions from August 1995 through November 1995. Mortality comparisons involved all Medicare patients nationwide with inpatient claims for acute myocardial infarctions during 2 periods, June 1992 through May 1993 and August 1995 through July 1996. INTERVENTION: Data feedback by peer review organizations. MAIN OUTCOME MEASURES: Quality indicators derived from clinical practice guidelines, length of stay, and mortality. RESULTS: Performance on all quality indicators improved significantly in the 4 pilot states. Administration of aspirin during hospitalization in patients without contraindications improved from 84% to 90% (P< .001), and prescription of beta-blockers at discharge improved from 47% to 68% (P < .001). Mortality at 30 days decreased from 18.9% to 17.1% (P = .005) and at 1 year from 32.3% to 29.6% (P < .001). These improvements in quality occurred during a period when median length of stay decreased from 8 days to 6 days. Performance on all quality indicators except reperfusion was better in the pilot states than in the rest of the nation in 1995, and the differences were statistically significant for aspirin use at discharge (P < .001), beta-blocker use (P < .001), and smoking cessation counseling (P = .02). Postinfarction mortality was not significantly different between the pilot states and the rest of the nation during the baseline period, although it was slightly but significantly better in the pilot states during the follow-up period (absolute mortality difference at 1 year, 0.9%; P = .004). CONCLUSIONS: The quality of care for Medicare patients with acute myocardial infarction has improved in the Cooperative Cardiovascular Project pilot states. Performance on the defined quality indicators appeared to be better in the pilot states than in the rest of the nation in 1995 and was associated with reduced mortality.

Alabama↗
PubMed1998

Competing risk analysis of men aged 55 to 74 years at diagnosis managed conservatively for clinically localized prostate cancer.

CONTEXT: The appropriate therapy for men with localized prostate cancer is uncertain. Until results of clinical trials are available, men and their physicians need guidance. OBJECTIVE: To estimate survival based on a competing risk analysis stratified by age at diagnosis and histologic findings for men diagnosed as having clinically localized prostate cancer and who were managed conservatively. DESIGN: Retrospective cohort study. SETTING: Connecticut Tumor Registry. PATIENTS: A total of 767 men with localized prostate cancer diagnosed between 1971 and 1984, aged 55 to 74 years at diagnosis, either not treated or treated with immediate or delayed hormonal therapy, and followed up for 10 to 20 years after diagnosis. MAIN OUTCOME MEASURES: Estimates of the probability of dying from prostate cancer or other competing hazards. RESULTS: Men with tumors that have Gleason scores of 2 to 4, 5, 6, 7, and 8 to 10 face a 4% to 7%, 6% to 11%, 18% to 30%, 42% to 70%, and 60% to 87% chance, respectively, of dying from prostate cancer within 15 years of diagnosis depending on their age at diagnosis. CONCLUSIONS: Men whose prostate biopsy specimens show Gleason score 2 to 4 disease face a minimal risk of death from prostate cancer within 15 years of diagnosis. Conversely, men whose biopsy specimens show Gleason score 7 to 10 disease face a high risk of death from prostate cancer when treated conservatively, even when cancer is diagnosed as late as age 74 years. Men with Gleason score 5 or 6 tumors face a modest risk of death from prostate cancer that increases slowly over at least 15 years of follow-up.

Aged↗
PubMed1996

Interethnic variability in birth weight and genetic background: a study of placental alkaline phosphatase.

The relationship between human placental alkaline phosphatase (PLAP) genotype and birth weight is investigated in a sample of white, black and Puerto-Rican new-born infants from New Haven, Connecticut (total 710 subjects). Black and Puerto-Rican infants show a higher incidence of growth retardation and a higher frequency of ALPp*1/*1 genotype as compared to whites. The proportion of newborns with a low birth weight (below the 10th percentile) is lower in infants with ALPp*1/*1 genotype than in those with other PLAP genotypes, especially among non-whites. It is argued that the higher frequency of ALPp*1 allele among non-whites might be, at least in part, a consequence of their adaptation in the past to environmental conditions adverse to optimal intrauterine development.

Black or African American↗
PubMed1996

Malignant melanoma risk factors by anatomic site: a case-control study and polychotomous logistic regression analysis.

This population-based case-control study systematically examined reported malignant melanoma risk factors by anatomic site. Study subjects consisted of 548 invasive melanoma cases diagnosed in Connecticut during 1987-1989 and 494 randomly selected controls. Multivariate polychotomous logistic regression was used to determine whether risk factors differed across anatomic sites. Risk factors examined included demographic and pigmentary characteristics, sun exposure-related factors, anatomic site-specific sunburn, recreational water activity clothing habits and number of nevi. A pattern of site-specificity was observed for sunburn. A history of sunburn at an anatomic site was specifically related to the development of malignant melanoma at that site more so than at other sites. This site-specificity was consistent with a direct role for intense, intermittent sun exposure in the development of melanoma. Age and gender were the only risk factors that differed significantly in effect across anatomic sites. The age difference was explained by differences in histologic subtype across sites. The gender difference could not be explained by sex differences in anatomic site-specific sunburns or in recreational water activity clothing habits. Alternative explanations include sex differences in behavioral patterns of sun exposure that we did not measure and as yet unelucidated differences in susceptibility to melanoma according to sex and anatomic site.

Adult↗
PubMed1977

Colorectal polyps and carcinoma in Southern Iran.

A study was made of the prevalence of colorectal polyps (excluding juvenile polyps, familial polyposis coli and villous adenomas) and the minimum frequency of colorectal carcinoma in Southern Iran. A total of 801 large intestines from necropsies performed on individuals 20 years or older was examined with or without magnifying lens for presence of polyps. Our prevalence rate was then compared with those reported on postmortem material from the USA, Australia, South Africa (Bantus), Colombia, and Hawaii (Japanese immigrants). Our surgical pathology files were reviewed for colorectal polyps over a 22-year period (1952-1973). Colorectal carcinomas diagnosed in the Department of Pathology were reviewed over 11 years (1963-1973) and the minimum frequency rates compared with corresponding age- and sex-specific incidence rates from Connecticut, USA. The data indicate 1) a very low prevalence rate for colorectal polyps as well as carcinoma in our region and 2) a rather striking predominance of right-sided colonic carcinoma.

Adenocarcinoma↗
PubMed1978

The relationship of marital status to survival from melanoma.

As an indirect test of the hypothesis that prior pregnancy has a favorable influence on prognosis in melanoma, the relation of marital status to survival among melanoma patients was examined in data gathered by the Connecticut Tumor Registry, 1935--1973. Compared to women who had never been married, ever-married women with the disease had a slightly increased survival rate, but the difference was not statistically significant. If a difference between parous and nulliparous women in survival from melanoma truly exists, it is probably a small one, and could be due to differences in characteristics other than childbearing.

Adult↗
PubMed1983

Esophageal carcinoma following irradiation for breast cancer.

A patient previously irradiated for inner-quadrant breast cancer developed a midesophageal stricture that on repeated biopsies showed pathologic changes consistent with acute and chronic radiation injury. Eventually a focus of well-differentiated esophageal carcinoma was found in the stricture. The patient was the second in a series of 20 patients treated at Georgetown University Hospital, Medical Oncology Division, 1973-1978, for esophageal cancer, who gave a history of previous irradiation for breast carcinoma. This finding led to the review of related case reports, follow-up studies on irradiated spondylitic patients, and data from the Connecticut Tumor Registry on esophageal cancer following breast carcinoma. These data suggest that the modest increase in risk for esophageal cancer reported in studies of atomic bomb survivors is of clinical significance to patients receiving therapeutic radiation, and, that specifically, women irradiated for inner-quadrant breast cancer, in which the dose of radiation to the esophagus can be large, may be at risk for subsequent esophageal carcinoma.

Adult↗
PubMed1985

A population-based study of survival after scrotal carcinoma.

In previous reports on scrotal carcinomas, overall 5-year survival rates have varied from 18% to 70% without explanation. In this study, survival was determined through the active follow-up of the Connecticut Tumor Registry for 65 cases of scrotal carcinoma diagnosed in the state from 1935 to 1980. The overall actuarial probability of surviving 5 years was 0.57. Stage and age at diagnosis were statistically significant predictors of survival (P less than 0.001 and P = 0.016, respectively). Survival varied progressively with combinations of these two variables with subjects younger than age 65 years and localized at diagnosis having 5-year survival of 0.75, compared to 0.17 for subjects age 65 years and older with regional or distant spread; these survival outcomes encompassed those of previous reports. With the passage of more than four decades, no improvement in survival was detectable. Initial radiotherapy, given to nine cases, also bore no detectable relationship to survival after adjustment for other variables. The 30 men in metalworking occupations previously shown to be associated with this cancer were not more frequently diagnosed with the cancer in localized stage, and showed a survival similar to that for the 29 men in other occupations.

Actuarial Analysis↗
PubMed1986

Risk of second malignancy after cancers of the renal parenchyma, renal pelvis, and ureter.

Risk of second primary malignancy was assessed in a population-based survey of persons who developed cancers of the renal parenchyma, renal pelvis, or ureter in Connecticut during the period 1935-1982. Among 4176 patients with a first primary tumor of the renal parenchyma, a second cancer was reported in 219 (5%), yielding a small but significantly elevated relative risk (RR) of 1.2, which reflects excesses for cancers of the bladder, kidney, and lymphatic-hematopoietic system. Among 939 patients with a first primary tumor of the renal pelvis or ureter, a second cancer was reported in 155 (17%), associated with a significantly elevated RR of 2.7. This resulted mainly from a 21-fold increase in risk for bladder cancer, although significant excesses were also found for lung and prostate cancers, and metachronous cancers of the renal pelvis and ureter. These associations seem to reflect the multicentric behavior of tumors arising in the urinary tract, the role of cigarette smoking, and host factors yet to be defined, and some degree of heightened medical surveillance and detection of tumors, especially in the same organ system.

Aged↗
PubMed1994

Increased risk of lung cancer after breast cancer radiation therapy in cigarette smokers.

BACKGROUND: Ionizing radiation is a lung carcinogen in a variety of settings, including after breast cancer radiation therapy. The authors explored whether cigarette smoking and breast cancer radiation therapy have a multiplicative effect on the risk of subsequent lung cancer. METHODS: This case-control study investigated women registered with primary breast cancer in the Connecticut Tumor Registry who developed a second malignancy between 1986 and 1989. Those diagnosed with a subsequent primary lung cancer were compared with those diagnosed with a subsequent nonsmoking, nonradiation-related second malignancy, and age-adjusted odds ratios were calculated with logistic regression. RESULTS: No radiation effects were observed within 10 years of initial primary breast cancer. Among both smokers and nonsmokers diagnosed with second primary cancers more than 10 years after an initial primary breast cancer, radiation therapy was associated with a 3-fold increased risk of lung cancer. A multiplicative effect was observed, with women exposed to both cigarette smoking and breast cancer radiation therapy having a relative risk of 32.7 (95% confidence interval [CI], 6.9-154). The radiation carcinogenic effect was observed only for the ipsilateral lung and not for the contralateral lung both in smokers and nonsmokers. CONCLUSIONS: Breast cancer radiation therapy, as delivered before 1980, increased the risk of lung cancer after ten years in nonsmokers, and a multiplicative effect was observed in smokers. For both smokers and nonsmokers, this effect was observed only for the ipsilateral lung and not the contralateral lung. Modern techniques, however, significantly decrease the radiation dose to the lungs, which may decrease the risk of lung cancer. Nonetheless, due to the available choices in early-stage breast cancer treatment, current practices may need to be revised for young breast cancer patients who smoke.

Breast Neoplasms↗
PubMed2000

Disordered eating among adolescents: associations with sexual/physical abuse and other familial/psychosocial factors.

OBJECTIVE: To examine associations between disordered eating behaviors and a range of familial/psychosocial factors, including sexual and physical abuse experiences, among adolescent girls and boys. METHOD: A statewide representative sample of 9,943 students in Grades 7, 9, and 11 in Connecticut completed a comprehensive survey on adolescent health within their schools. The present analysis focused on measures of disordered eating, sexual and physical abuse, familial factors, peer support, and depressive symptoms. RESULTS: Youth at increased risk for disordered eating included those who perceived family communication, parental caring, and parental expectations as low and those who reported sexual or physical abuse experiences. After adjusting for differences in familial/psychosocial factors, associations between abuse experiences and disordered eating were weakened. However, youth who reported sexual abuse were still at increased risk for disordered eating, even after adjusting for physical abuse, sociodemographics, and familial/psychosocial factors (girls: odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.51, 2.64; boys: OR = 4.88, 95% CI = 2.94, 8.10). Youth reporting physical abuse were also at increased risk for disordered eating after adjusting for sexual abuse, sociodemographics, and familial/psychosocial factors (girls: OR = 2. 00, 95% CI = 1.52, 2.62; boys: OR = 1.95, 95% CI = 1.26, 3.04). DISCUSSION: The findings suggest that strong familial relationships may decrease the risk for disordered eating among youth reporting abuse experiences, but both sexual and physical abuse are strong independent risk factors for disordered eating among both adolescent girls and boys.

Adolescent↗