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At least 1,765 records · Page 98Linked to original sources
PubMed1994

Incidence of hospitalization for digitalis toxicity among elderly Americans.

OBJECTIVE: To document the prevalence of digitalis use and the incidence of hospitalization caused by digitalis toxicity. DESIGN: Observational cohort followed for 6 years. SETTING: Urban community. PARTICIPANTS: Persons were eligible if they were (1) enrolled in the Yale Health and Aging Project and (2) using digitalis when interviewed in 1982 or 1985. The Project comprises a sample of noninstitutionalized persons aged 65 years and over living in New Haven, Connecticut. METHODS: Between 1982 and 1988 when a Project participant was hospitalized in New Haven, a researcher reviewed the medical record and coded up to 16 International Classification of Diseases-Class 9 (ICD-9) diagnoses. To identify hospitalizations caused by digitalis, we reexamined records with ICD-9 codes suggesting toxicity. We confirmed the admission illness was an adverse drug reaction with a decision algorithm. RESULTS: The prevalence of digitalis use was 13% in 1982 and 12% in 1985. The incidence of hospitalization caused by definite or probable toxicity was 4.2% (95% confidence interval = 0.3% to 8.1%) over 6 years. Manifestations of toxicity were malaise or gastrointestinal symptoms (two patients) and heart block plus malaise or gastrointestinal symptoms (six patients). Use of quinidine was associated (P < .05) with toxicity. CONCLUSION: Knowledge about the incidence of severe, morbid toxicity may help clinicians estimate and compare the risks and benefits of digitalis and alternate therapies.

Aged↗
PubMed1985

Ultrasound prediction of fetal weight in prolonged pregnancy.

In this study we applied two commonly used birth weight prediction equations to a sample of 121 women with prolonged pregnancies. Subjects had sonographic measurements of biparietal diameter and abdominal perimeter taken within 2 days of delivery at Parkland Memorial Hospital. Although the two prediction equations were obtained from a population of women in New Haven, Connecticut, who delivered over a wide range of gestational ages, when the equations were applied to the sample of prolonged pregnancies in Dallas, Texas, there was a strong correlation (0.71) between predicted and actual birth weight. Moreover, reestimation of the New Haven equations with use of the Dallas data yielded similar regression coefficients. Finally, birth weight prediction equations for black, white, and Hispanic patients in Dallas were not significantly different. These findings suggest a remarkably constant relationship between fetal head and abdominal dimensions and birth weight over different gestational ages and for different population groups.

Birth Weight↗
PubMed1989

Other cancers in uveal melanoma patients and their families.

To determine associations with other cancers, 400 consecutive uveal melanoma patients examined at Wills Eye Hospital between 1984 and 1985 were surveyed regarding personal and family history of cancer. Responses were received from 333 (83%). Sixty patients reported 43 nonbasal cell second primary cancers, which were confirmed pathologically or by physician records. The overall prevalence of nonbasal cell cancers diagnosed in uveal melanoma patients by December 1985 was over two times greater than the expected prevalence, based on the Connecticut Tumor Registry data for an age- and sex-matched population. Gynecologic cancers tended to be more common in uveal melanoma female patients than in the comparison population. Although the observed prevalence of cutaneous melanoma was not significantly greater than expected, three cases with both primary cutaneous and uveal melanoma were reported. Family histories of cutaneous melanoma were confirmed in 14 patients, and uveal melanoma in two patients. Data suggested that the overall cancer prevalence in uveal melanoma patients may be increased, that hormonal factors may play a role in the genesis of this malignancy, and that there may be a link between cutaneous and uveal melanoma.

Aged↗
PubMed1978

The use of regression constants in estimating tooth size in a Negro population.

A study of a sample of 105 Negro children and adolescents, residents of Connecticut, was undertaken to determine the degree of correlation between mandibular tooth size and the size of the canines and premolars. The correlation between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary or mandibular canine and first and second premolars was found to be 0.63 and 0.71, respectively. Further, regression constants were determined in an attempt to estimate the buccal segments from the mandibular incisors.

Adolescent↗
PubMed1975

Problem-oriented surgical audit in the community hospital. A concept in evolution.

A system of surgical audit based on identification and solution of surgical problems is described. The system relies initially on universal review of patient records on a monthly basis by surgeons in the involved institution. Evolution of the system to one which the records of certain patients can be excluded from review by physicians is seen as practical, if careful definition of such records is maintained. Emphasis on the goal of meaningful quality of care assessment is critial. Utilizing this system, surgeons in Stamford, Connecticut, have found significant deficiencies in diagnostic, therapeutic, or both of these aspects of patient care in 5 per cent of records reviewed. Ninety-five per cent of patients were judged to have had no important inadequacies in their surgical care, based on evidence in their medical records. Attempts to evaluate surgeons' behavioral changes, when deficiencies in their patients' care have been demonstrated, are being pursued actively.

Connecticut↗
PubMed1992

The role of prophylactic oophorectomy in the avoidance of ovarian cancer.

OBJECTIVE: To determine the role of prophylactic oophorectomy at elective hysterectomy in the avoidance of ovarian cancer. METHOD: A survey was performed of all members of the Society of Gynecologic Oncologists and all obstetrician-gynecologists in the State of Connecticut. RESULT: Seventy-nine percent of gynecologic oncologists and 72% of obstetrician-gynecologists surveyed reported 0-1% of women would be saved from ovarian cancer if one ovary was removed at elective hysterectomy at age 45 years. If both ovaries were removed, 8.4% and 32.1% of these physicians respectively responded that 95-100% of women could be saved from ovarian cancer. Approximately 50% responded that macroscopic appearance and frozen section studies at surgery were helpful in deciding whether to remove ovaries at hysterectomy. A literature review suggested that 12% of ovarian cancers might be avoided if women undergo prophylactic oophorectomy at elective hysterectomy. CONCLUSION: There is a lack of well-designed epidemiologic studies evaluating risk factors for ovarian cancer and the role of prophylactic oophorectomy at elective hysterectomy.

Aged↗
PubMed1975

A state-wide survey of index pediatric surgical conditions.

A statewide survey of pediatric surgery was sponsored by the Connecticut Society of American Board Surgeons to determine the general surgeons attitudes about performing routine and complex pediatric surgery, the absolute volume of index pediatric surgical conditions in the state, and the proportion treated by pediatric and nonpediatric surgeons. The incidence of index conditions studied was very similar to those previously reported. Approximately one half of all index cases were treated by nonpediatric surgeons, indicating that the number of pediatric surgeons could be increased, and possibly doubled, if all index procedures were performed by pediatric surgeons. Two-thirds of responding surgeons recognized the need for a regional neonatal surgical center. Regional or statewise surveys of index surgical conditions are recommended to determine regional manpower needs.

Adolescent↗
PubMed1985

Survival with localized carcinoma: radical prostatectomy vs radiation therapy.

The charts of all patients receiving radical surgery and radiation therapy for cancer localized to the prostate in the years 1950 to 1977 in the State of Connecticut were reviewed. Long-term survival rates at ten and fifteen years were considerably better in those patients treated with radical surgery.

Actuarial Analysis↗
PubMed1990

Cancer-related maternal mortality in Massachusetts, 1954-1985.

Cancer-related maternal mortality is a rare event. We report the first population-based study of this issue using data collected by the Committee on Maternal Welfare of the Massachusetts Medical Society between 1954 and 1985. The incidence of cancer-related maternal mortality during the study period fell from 3.16 to 0 per 100,000 live births. The most common cancer-associated maternal deaths were due to central nervous system tumors and hematological cancers. To determine the effects of pregnancy on cancer mortality, we compared our data with figures from the Connecticut Register of Mortality for Women aged 15-44. In the pregnant group there was a significantly higher incidence of mortality due to central nervous system tumors and a significantly lower incidence of mortality due to breast cancer. The data suggest that pregnancy may not be contraindicated for a woman with a history of breast cancer, but may be contraindicated for a woman with a history of a central nervous system tumor.

Adolescent↗
PubMed1985

An epidemiologic study of the carpal tunnel syndrome in an adult female population.

The relationships between certain reproductive, demographic, and medical variables and the carpal tunnel syndrome were examined using data from a hospital-based case-control study of women ages 45 to 74 years in the New Haven and Hartford, Connecticut, areas from 1977 to 1979. Characteristics of 40 carpal tunnel syndrome cases and 1,043 controls from hospital surgical services were compared. A history of diabetes was associated with an increased frequency of occurrence of the carpal tunnel syndrome, a finding consistent with clinical observation. Recent weight gain and use of estrogen replacement therapy were identified as possible risk factors; this provides some support for the theory that fluid retention in the soft tissues of the carpal tunnel is etiologically involved, although these results are preliminary and further research must be carried out to refute or support these findings. The negative association of the carpal tunnel syndrome with height and a history of varicose veins and the positive association with age at menopause cannot be explained and need verification.

Age Factors↗
PubMed1990

Knowledge of colorectal cancer and use of screening tests in persons 40-74 years of age.

Telephone surveys were conducted in 1988 on random samples of persons ages 40-74 years in two populations with relatively high rates of colorectal cancer, i.e., in Long Island (NY) and in Connecticut. Correct responses to questions concerning warning signs for and the frequency of colorectal cancer relative to stomach cancer were not related to age but were positively associated with educational level and were greater among females than males. Awareness of the possible role of dietary factors in cancer (i.e., regarding both cured meat and fiber-rich foods) was high, while daily consumption of bran cereals was infrequent. Proportions of respondents who reported having colorectal screening tests increased with age and were higher among college graduates and among those having annual medical check-ups (especially for college graduates). In multivariate analyses age (i.e., 60-74 vs 40-59 years) and education (i.e., college graduates vs all others), along with frequency of medical check-ups, were significant independent predictors of use of colorectal screening tests (both fecal occult blood and proctoscopy), while gender (female) was negatively associated with proctoscopy. Implications for planning intervention programs are discussed.

Adult↗
PubMed1991

Projections of the breast cancer burden to U.S. women: 1990-2000.

Although breast cancer incidence rates in the United States have been climbing for the last 40 years, recent trends have shown a more dramatic increase since 1982. This recent rise has been the subject of much study, and it is likely due in part to increased mammographic screening. A mathematical model incorporating the long-term incidence trend estimated from the Connecticut Tumor Registry and recent increases in availability of dedicated mammography machines is described and used to project incidence rates. Projections of breast cancer incidence rates among U.S. women ages 50 and over from 1990 to the year 2000 are developed. It appears that breast cancer incidence rates will continue to rise until about 1990 and then decline as screening rates stabilize.

Adult↗
PubMed1979

The current status of placebo in hospital practice.

Despite a voluminous literature on the topic of placebo, there has been little documentation of either actual clinical practice of prescribing placebo or the attitudes that surround it. Through a questionnaire survey of all head nurses of clinical units in one health services area of Connecticut, data were obtained on current practices regarding placebo use in the natural hospital setting. Multiple reasons for placebo use in the natural hospital setting. Multiple reasons for placebo use were given, and it was noted that patients receiving placebo tended to be viewed in certain ways. The effectiveness of placebo in symptom relief was reported as nearly double that reported in the experimental literature. Methodologic issues of the study and of placebo investigation, in general, are discussed. Because common clinical problems appear to generate most instances of placebo use, several issues pertinent to medical education are raised. Some future directions for placebo research are proposed.

Adolescent↗
PubMed1983

Patient satisfaction and visiting the doctor: a self-regulating system.

In 1974, Aday and Anderson proposed that client satisfaction may affect utilization of physician services, and that utilization, in turn, may affect satisfaction. Since that time, a number of researchers have investigated the issue, adopting increasingly sophisticated approaches. To date, however, the statistical models used to test the hypothesized feedback have not been completely appropriate. We develop and test alternative hypotheses on the reciprocal effects of satisfaction and utilization. Using methods that allow us to specify models with feedback effects, we examine whether satisfaction with the doctor and visits to the doctor form a self-regulating or a self-amplifying system. In both, satisfaction is expected to result in more visits to the doctor, but in a self-regulating system, visits are hypothesized satisfaction. We specify and test the feedback model in two data sets: one based on a cross-sectional survey of pediatric practices in New Haven, Connecticut and the other based on Gray's panel survey of the Federal Employees Health Benefits Program. In both cases the results indicate that satisfaction and visits form a self-regulating system.

Connecticut↗
PubMed1979

Solar cycles and malignant melanoma.

There has been a sixfold increase in the incidence of malignant melanoma in the State of Connecticut during the past forty years. Superimposed on a steady incidence rise are cycles of markedly increased incidence rates which follow periods of maximum sunspot activity. We propose that the effect of sunspot cycles on human melanoma occurrence is mediated by modulation of stratospheric ozone and thus indirectly affects UV flux at the earth's surface. This hypothesis would predict a time lag in melanoma incidence cycles, relative to sunspot activity, with increasing distance from polar caps. This appears to be the case. The increase in melanoma incidence related to a given reduction in ozone depletion in this hypothesis, is in great excess of existing models relating anthropogenic ozone depletion and skin cancer.

Connecticut↗
PubMed1987

Clinical and ecological characteristics of Vibrio vulnificus in the northeastern United States.

Multiple seawater sites in the northeastern United States, particularly Long Island Sound, and shellfish from Long Island Sound were sampled from April to November for 3 successive yr, 1983-1985. Hospitals in coastal and metropolitan areas of Connecticut were surveyed for the same 3-yr period, Vibrio vulnificus can be found in these waters during the summer months. The appearance of these virulent bacteria in both seawater and shellfish are a function of the water temperature; no V. vulnificus could be isolated until the temperature was approximately 17 degrees C. Although the risk of infection is small, as shown by isolation of this organism from patients, certain high-risk groups exist. Consumption of raw shell fish during the summer months should be discouraged in people with liver disease or patients on immunosuppressive therapy.

Animals↗
PubMed1989

Regional use of violent suicide methods: an analysis of suicide attempts in Houston, Texas.

A number of changes in the demographics of suicide and suicide attempters have occurred in the last 10 to 15 years. To assess some of the factors that may be involved in these changes, this study examines a group of suicide attempters in Houston, Texas, where a large percentage of the attempts were violent. These violent attempters are compared with nonviolent attempters, and the entire population of attempters is compared with suicide attempters in New Haven, Connecticut. Finally, the two attempter populations are compared with the underlying general population demographics of two regions (Houston and New Haven). Several differences emerged between attempters in Houston and in New Haven, including larger proportions of violent attempters, male attempters, and married attempters in Houston. Demographic factors in the general populations for the two regions are different, but these differences are not directly reflected in the nature of the attempter populations. Reasons for observed differences are discussed.

Adolescent↗
PubMed1989

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors.

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward one's illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Connecticut↗