Linking crash and breathalyzer data in Connecticut.

OBJECTIVES: To document the process of linking breathalyzer and motor vehicle crash (MVC) data for the State of Connecticut using a unique identifier in the place of personal and private information. METHODS: Deterministic linkage methodologies were utilized in Microsoft SQL Server to join 5,634 (of 6,650) breathalyzer records to corresponding MVC driver records for the period of January 1, 2017 to December 31, 2022. Differences between the linked and original datasets were documented by comparing the consistency of frequency and proportion distributions of key variables. RESULTS: Proportions of annual records, alcohol breath tests, and refusals were nearly unchanged when comparing linked and original breathalyzer data. When examining variables in the original MVC driver records, there were differences in the within-group proportions for sex and age, with an overrepresentation of males and drivers aged 26-to-40 years old. For crash and injury severity, the linked dataset had lower proportions of more severe injury records when compared to the original MVC data. Additionally, 1,007 breathalyzer records were not matched with an associated MVC record. CONCLUSIONS: Linkage methodology is sound and produced quality matches. The use of a unique identifier provided a strong match qualifier in the absence of personal and private data. Changes in proportions for age, sex, crash and injury severity align with previous research. Potential missed matches may be attributed to several factors outside of the linkage process, including data discrepancies and varied reporting practices. Future studies will further explore these differences and incorporate additional toxicology data as part of a continued effort to fuze crash, citation, toxicology, and public health data. The end result will be a holistic, comprehensive, and multifaceted database for transportation research and education.

A Colocalized Hepatitis C Virus Clinic in a Primary Care Practice Improves Linkage to Care in a High Prevalence Population.

BACKGROUND: There is an urgent need to increase patient access to treatment of chronic hepatitis C virus (HCV) infection. We developed a colocalized HCV clinic integrated within a primary care practice. We report the prevalence of HCV and evaluate the impact of the integrated clinic on the HCV cascade of care. METHODS: We performed a retrospective study of patients with chronic HCV infection from 2 clinic practices, an integrated clinic practice and a similar nonintegrated clinic practice, between July 2015 and July 2016. Demographic, clinical, and HCV testing data were reviewed to estimate the prevalence of chronic HCV and to construct a cascade of care. RESULTS: A total of 8405 primary care patients were included; 4796 (57.1%) received an HCV antibody test and 390 (8.1%) were positive. A total of 310 patients with chronic HCV were included in the analysis. There were 119 patients eligible for linkage to care in the nonintegrated clinic, of which 80 (67.2%) were referred, 38 (31.9%) were linked, and 18 (15.1%) initiated treatment during the study period. Among the 70 patients eligible for linkage to care in the integrated clinic practice, 51 (72.9%) were referred, 38 (54.3%) were linked, and 16 (22.9%) initiated treatment. In a multivariable analysis, patients in the integrated clinic practice had significantly higher odds of being linked to care than patients in the nonintegrated clinic practice (adjusted odds ratio [OR] 2.5, 95% confidence interval [CI] = 1.3-4.8). CONCLUSIONS: We found a high seroprevalence of chronic HCV within our clinic population and demonstrate that a HCV clinic integrated into a primary care center increases linkage to care for patients with chronic HCV.

Phytoestrogens and Thyroid Cancer Risk: A Population-Based Case-Control Study in Connecticut.

BACKGROUND: Very few previous studies have examined the relationship between thyroid cancer risk and intake of phytoestrogens (PE); furthermore, these studies have reached inconsistent results. METHODS: We analyzed data from a population-based case-control study in Connecticut from 2010 to 2011, including 387 histologically confirmed thyroid cancer cases and 433 population-based controls, with compound data available concerning specific PEs. Multivariate unconditional logistic regression models were used to estimate the associations between specific PEs and the risk of thyroid cancer, adjusting for potential confounders. RESULTS: An elevated risk of thyroid cancer was associated with moderate to high levels of coumestrol intake [OR = 2.48, 95% confidence interval (CI), 1.39-4.43 for 40-80 µg/day; OR = 2.41, 95% CI, 1.32-4.40 for 80-130 µg/day; and OR = 2.38, 95% CI, 1.26-4.50 for >200 µg/day compared with <40 µg/day], and the main elevation in risk appeared among microcarcinomas (≤1 cm). A decreased risk of papillary macrocarcinomas (>1 cm; OR = 0.26, 95% CI, 0.08-0.85 for 1,860-3,110 µg/day compared with <760 µg/day) was associated with moderate genistein intake among women. CONCLUSIONS: Our study suggests that high coumestrol intake increases the risk of thyroid cancer, especially microcarcinomas, whereas moderate amounts of genistein intake appear to be protective for females with thyroid macrocarcinomas. IMPACT: The study highlights the importance of distinguishing between microcarcinomas and macrocarcinomas in future research on the etiology of thyroid cancer.

Nuclear shape and orientation features from H&E images predict survival in early-stage estrogen receptor-positive breast cancers.

Early-stage estrogen receptor-positive (ER+) breast cancer (BCa) is the most common type of BCa in the United States. One critical question with these tumors is identifying which patients will receive added benefit from adjuvant chemotherapy. Nuclear pleomorphism (variance in nuclear shape and morphology) is an important constituent of breast grading schemes, and in ER+ cases, the grade is highly correlated with disease outcome. This study aimed to investigate whether quantitative computer-extracted image features of nuclear shape and orientation on digitized images of hematoxylin-stained and eosin-stained tissue of lymph node-negative (LN-), ER+ BCa could help stratify patients into discrete (<10 years short-term vs. >10 years long-term survival) outcome groups independent of standard clinical and pathological parameters. We considered a tissue microarray (TMA) cohort of 276 ER+, LN- patients comprising 150 patients with long-term and 126 patients with short-term overall survival, wherein 177 randomly chosen cases formed the modeling set, and 99 remaining cases the test set. Segmentation of individual nuclei was performed using multiresolution watershed; subsequently, 615 features relating to nuclear shape/texture and orientation disorder were extracted from each TMA spot. The Wilcoxon's rank-sum test identified the 15 most prognostic quantitative histomorphometric features within the modeling set. These features were then subsequently combined via a linear discriminant analysis classifier and evaluated on the test set to assign a probability of long-term vs. short-term disease-specific survival. In univariate survival analysis, patients identified by the image classifier as high risk had significantly poorer survival outcome: hazard ratio (95% confident interval) = 2.91(1.23-6.92), p = 0.02786. Multivariate analysis controlling for T-stage, histology grade, and nuclear grade showed the classifier to be independently predictive of poorer survival: hazard ratio (95% confident interval) = 3.17(0.33-30.46), p = 0.01039. Our results suggest that quantitative histomorphometric features of nuclear shape and orientation are strongly and independently predictive of patient survival in ER+, LN- BCa.

Muscle-building supplement use and increased risk of testicular germ cell cancer in men from Connecticut and Massachusetts.

BACKGROUND: No analytic epidemiological study has examined the relationship between use of muscle-building supplements (MBSs) and testicular germ cell cancer (TGCC) risk. METHODS: We conducted a population-based case-control study including 356 TGCC cases and 513 controls from Connecticut and Massachusetts. RESULTS: The odds ratio (OR) for ever use of MBSs in relation to risk of TGCC was significantly elevated (OR=1.65, 95% confidence interval (CI): 1.11-2.46). The associations were significantly stronger among early users, men with more types of MBSs used, and longer periods of use. CONCLUSIONS: MBS use is a potentially modifiable risk factor that may be associated with TGCC.

The utility of inpatient rebound bilirubin levels in infants readmitted after birth hospitalization for hyperbilirubinemia.

BACKGROUND AND OBJECTIVES: There are few data evaluating the role of inpatient rebound bilirubin levels in the management of infants readmitted after their birth hospitalization for indirect hyperbilirubinemia. The goal of the present study was to evaluate the clinical utility of inpatient rebound bilirubin levels within this patient population. METHODS: A retrospective cohort study was conducted of 226 infants readmitted after their birth hospitalization for indirect hyperbilirubinemia. Data from 130 infants with rebound bilirubin levels drawn at a mean of 6.1±2.4 hours after discontinuation of phototherapy were compared with data from 96 infants without rebound bilirubin levels. The primary outcome was readmission to the hospital, and secondary outcomes included length of stay and discharge time. A subgroup analysis compared characteristics of children who required repeat phototherapy versus those who did not. RESULTS: Overall, 5 of 130 patients from the rebound group were readmitted compared with 4 of 96 patients from the no-rebound group (P=.98). Length of stay was significantly longer for patients with rebound bilirubin levels (27.7 vs 23.2 hours; P=.001). Patients with bilirubin levels lowered to ≤14 mg/dL were less likely to receive repeat phototherapy than those with levels>14 mg/dL (2 of 129 vs 12 of 97; P=.001). CONCLUSIONS: Early inpatient rebound bilirubin levels do not successfully predict which patients will require hospital readmission for repeat phototherapy. Children with bilirubin levels lowered to ≤14 mg/dL with phototherapy are unlikely to receive repeat phototherapy.

Functional cobalamin (vitamin B12) deficiency: role of advanced age and disorders associated with increased oxidative stress.

BACKGROUND/OBJECTIVE: Functional cobalamin (Cbl; vitamin B12) deficiency (that is, high levels of the Cbl-dependent metabolites, methylmalonic acid (MMA) and homocysteine (HCys), despite normal serum Cbl values) is common in the elderly and is associated with neurocognitive abnormalities, but its cause is unknown. As only reduced Cbls are metabolically active, the possibility that functional Cbl deficiency is associated with disorders having biomarkers indicative of increased oxidative stress (oxidant risks) was considered. SUBJECTS/METHODS: A retrospective record review of community-dwelling adults evaluated over a 12-year period for Cbl deficiency in a primary care setting who had serum Cbl values ⩾400 pg/ml (n=170). RESULTS: When no oxidant risks were present, older subjects (⩾70 years) had higher metabolite values than younger individuals (<70 years). MMA values were even higher in the elderly when one oxidant risk was present and in younger subjects when two or more oxidant risks were present. Even at Cbl levels ⩾800 pg/ml, MMA values were increased in 73% of elderly subjects with at least one oxidant risk. HCys values were also higher in both age groups when at least two oxidant risks were present. Cyanocobalamin therapy decreased MMA and HCys values in 86 and 76% of subjects, respectively, with nonresponders more likely to have two or more oxidant risks. CONCLUSION: Functional Cbl deficiency is associated with disorders marked by increased oxidative stress particularly in the elderly; it occurs even when Cbl levels are high and is not consistently corrected with high-dose cyanocobalamin therapy. Thus, current approaches to recognizing and managing this disorder may be inadequate.

Omega-3 and omega-6 fatty acid intakes and endometrial cancer risk in a population-based case-control study.

PURPOSE: Animal and laboratory studies suggest that long-chain omega-3 (n-3) fatty acids, a type of polyunsaturated fat found in fatty fish, may protect against carcinogenesis, but human studies on dietary intake of polyunsaturated fats and fish with endometrial cancer risk show mixed results. METHODS: We evaluated the associations between endometrial cancer risk and intake of fatty acids and fish in a population-based sample of 556 incident cancer cases and 533 age-matched controls using multivariate unconditional logistic regression methods. RESULTS: Although total n-3 fatty acid intake was not associated with endometrial cancer risk, higher intakes of eicosapentaenoic (EPA 20:5) and docosahexaenoic (DHA 22:6) fatty acids were significantly associated with lower risks (OR = 0.57, 95 % CI: 0.39-0.84; OR = 0.64, 95 % CI: 0.44-0.94; respectively) comparing extreme quartiles. The ratio of n-3:n-6 fatty acids was inversely associated with risk only on a continuous scale (OR = 0.84, 95 % CI: 0.71-0.99), while total fish intake was not associated with risk. Fish oil supplement use was significantly associated with reduced risk of endometrial cancer: OR = 0.63 (95 % CI: 0.45-0.88). CONCLUSIONS: Our results suggest that dietary intake of the long-chain polyunsaturated fatty acids EPA and DHA in foods and supplements may have protective associations against the development of endometrial cancer.

Microbial spectrum and resistance patterns in endophthalmitis: a 21-year (1988-2008) review in northeast United States.

PURPOSE: To study the microbial spectrum and antibacterial susceptibility of vitreous cultures in a tertiary referral center in Northeast United States. METHODS: All vitreous samples sent to the microbiology laboratory at a tertiary referral center from January 1988 to December 2008 were included in the study. The distribution and antibiotic susceptibility of all isolates from culture-positive samples were compared across 3 equal time periods 1988-1994, 1995-2001, and 2002-2008. RESULTS: One hundred forty-three positive cultures, where 11.9% (n=17) were polymicrobial, yielded a total of 160 isolates that consisted of 80.6% (n=129) gram-positive isolates, 12.5% (n=20) gram-negative isolates, and 6.9% (n=11) fungal isolates. The most prevalent organisms were coagulase-negative Staphylococcus (CoNS) (37.5%, n=60), Viridans Streptococcus (11.3%, n=18), and Streptococcus pneumoniae (6.9%, n=11). Other common gram-positive isolates include Propionibacterium acnes (5.6%, n=9), other Streptococcus species (4.4%, n=7), Staphylococcus aureus (4.4%, n=7), and Enterococcus faecalis (3.8%, n=6). The most common gram-negative isolates were Klebsiella species (3.1%, n=5), Moraxella species (3.1%, n=5), and Haemophilus species (2.5%, n=4). Vancomycin was effective against all CoNS, Sta. aureus, Viridans Streptococcus, and E. faecalis tested, and all Sta. aureus isolates were oxacillin sensitive. Of all CoNS isolates, 83.3% during 1988-1994, 73.1% during 1995-2001, and 100% during 2002-2008 were resistant to at least 1 of the antibiotics tested in the study with the last time period showing an increase in resistance (P=0.021, adjusted standard residual=2.0). CoNS showed a decreasing resistance over time to chloramphenicol and gentamicin (P=0.010, P=0.007, respectively) and an increase in resistance to penicillin and tetracycline during 2002-2008 (P=0.003, P=0.040, respectively). Susceptibility to other antibiotics did not show significant dependence on time. CONCLUSION: Bacteria causing endophthalmitis showed variable resistance to antibiotics over time. The importance of adequately treating endophthalmitis in the setting of these resistance pattern changes stresses the importance of periodic evaluation of causative organisms to ensure appropriate empiric treatment.

Effects of ambient pollen concentrations on frequency and severity of asthma symptoms among asthmatic children.

BACKGROUND: Previous studies on the associations between ambient pollen exposures and daily respiratory symptoms have produced inconsistent results. We investigated these relationships in a cohort of asthmatic children using pollen exposure models to estimate individual ambient exposures. METHODS: Daily symptoms of wheeze, night symptoms, shortness of breath, chest tightness, persistent cough, and rescue medication use were recorded in a cohort of 430 children with asthma (age 4-12 years) in Connecticut, Massachusetts, and New York. Daily ambient exposures to tree, grass, weed, and total pollen were estimated using mixed-effects models. We stratified analyses by use of asthma maintenance medication and sensitization to grass or weed pollens. Separate logistic regression analyses using generalized estimating equations were performed for each symptom outcome and pollen type. We adjusted analyses for maximum daily temperature, maximum 8-hour average ozone, fine particles (PM2.5), season, and antibiotic use. RESULTS: Associations were observed among children sensitized to specific pollens; these associations varied by use of asthma maintenance medication. Exposures to even relatively low levels of weed pollen (6-9 grains/m(3)) were associated with increased shortness of breath, chest tightness, rescue medication use, wheeze, and persistent cough, compared with lower exposure among sensitized children on maintenance medication. Grass pollen exposures ≥ 2 grains/m(3) were associated with wheeze, night symptoms, shortness of breath, and persistent cough compared with lower exposure among sensitized children who did not take maintenance medication. CONCLUSION: Even low-level pollen exposure was associated with daily asthmatic symptoms.

A survey of training and practice patterns of massage therapists in two US states.

BACKGROUND: Despite the growing popularity of therapeutic massage in the US, little is known about the training or practice characteristics of massage therapists. The objective of this study was to describe these characteristics. METHODS: As part of a study of random samples of complementary and alternative medicine (CAM) practitioners, we interviewed 226 massage therapists licensed in Connecticut and Washington state by telephone in 1998 and 1999 (85% of those contacted) and then asked a sample of them to record information on 20 consecutive visits to their practices (total of 2005 consecutive visits). RESULTS: Most massage therapists were women (85%), white (95%), and had completed some continuing education training (79% in Connecticut and 52% in Washington). They treated a limited number of conditions, most commonly musculoskeletal (59% and 63%) (especially back, neck, and shoulder problems), wellness care (20% and 19%), and psychological complaints (9% and 6%) (especially anxiety and depression). Practitioners commonly used one or more assessment techniques (67% and 74%) and gave a massage emphasizing Swedish (81% and 77%), deep tissue (63% and 65%), and trigger/pressure point techniques (52% and 46%). Self-care recommendations, including increasing water intake, body awareness, and specific forms of movement, were made as part of more than 80% of visits. Although most patients self-referred to massage, more than one-quarter were receiving concomitant care for the same problem from a physician. Massage therapists rarely communicated with these physicians. CONCLUSION: This study provides new information about licensed massage therapists that should be useful to physicians and other healthcare providers interested in learning about massage therapy in order to advise their patients about this popular CAM therapy.

Use of a continence nurse specialist in an extended care facility.

PURPOSE: The aim of this study was to determine if the number of incontinence episodes for an elderly female population could be decreased through an individualized continence program in a Connecticut long-term care center. METHODS: Forty-two female residents who in a long-term care facility who were incontinent or had urgency related to overactive bladder were included in the incontinence program. Total numbers of incontinent episodes for each participant were recorded 1 week prior to the study. An individualized plan of care for each patient was developed by the continence specialist and the plan of care implemented for at least 1 year. FINDINGS: After the continence specialist recommended a program of treatment and the program of treatment was implemented for 1 year, the number of UTIs (31 preintervention year; 6 postintervention year) and pressure ulcers (15 preintervention year; 2 postintervention year) were substantially decreased and the number of falls cut by more than 50% (18 preintervention; 7 postintervention). CONCLUSION: A nurse continence specialist can be used to help long-term care facilities plan a program that will direct individualized nursing interventions that will improve patient outcomes related to UTI, pressure sore and fall rates, and reduce the costs of care.

Nutritional rickets with normal circulating 25-hydroxyvitamin D: a call for reexamining the role of dietary calcium intake in North American infants.

The incidence of nutritional rickets appears to be increasing in North American infants and toddlers; it is widely assumed that this is due to vitamin D deficiency. Thus, records of 43 children with nutritional rickets from greater New Haven, Connecticut, from 1986-2002 were identified. The mean age of presentation was 20 months; 86% were of African-American, Hispanic, or Middle Eastern descent. More than 93% of children had been breastfed; however, 15% had received vitamin D supplementation. Eighty-six percent of those with food histories available were weaned to diets with minimal dairy content after nursing. Serum 25-hydroxyvitamin D was 20.9 +/- 11.5 ng/ml and was less than 15 ng/ml in only 22% of patients. Three representative case histories suggest that dietary calcium intake may play a contributory role in the development of disease; 1 case documents radiographic and biochemical resolution of rachitic abnormalities after calcium treatment, but no vitamin D therapy. Clinicians should be aware that low dietary calcium intake after weaning may result in the development of nutritional rickets, and that attention to calcium intake as well as that of vitamin D is important in the establishment of optimal dietary practices for North American infants and children.

The relationship of spirituality and health outcomes in Black women with type 2 diabetes.

The purpose of this pilot study was to explore the relationships between spiritual well-being emotional distress, HbA1c values, and blood pressure levels in a convenience sample of 22 Black women with type 2 diabetes. Results revealed significant inverse correlations between diastolic blood pressure (BP) and both total spiritual well-being (r=-.51, P=.02) and religious well-being (RWB) (r=-.55, P=.01). Women with higher RWB scores tended to have lower diastolic BP, as compared to their counterparts with lower RWB scores (z=2.78, P=.005). Emotional distress was positively related to systolic BP (r=.48, P=.03). These finding suggest that holistic care, addressing the spiritual and emotional dimensions, may foster improved BP levels among Black women with type 2 diabetes, thereby potentially reducing their high risk for secondary complications.

Comparison of problem-gambling and non-problem-gambling youths seeking treatment for marijuana abuse.

OBJECTIVE: To evaluate the prevalence and correlates of problem gambling (PG) in marijuana-abusing adolescents. METHOD: A retrospective analysis was conducted of data collected from participants entering treatment for marijuana abuse in Philadelphia, Pennsylvania, and Hartford, Connecticut, between 1998 and 2000. RESULTS: Of 255 adolescents interviewed, 22% experienced gambling problems. Compared with non-problem gamblers (NPGs), PGs were more likely to be male, of African-American ethnicity, and to live in single-parent homes. Multivariate general linear models compared the two groups with respect to psychosocial problems. After controlling for age, gender, and race, differences between the groups emerged in drug use severity, legal difficulties, psychiatric problems, and human immunodeficiency virus risk behaviors. PGs reported a greater frequency of overall drug and alcohol use and greater intensity of marijuana use than their NPG counterparts. They had more illegal activity and greater somatization and anxiety symptoms, as well as higher levels of victimization. Compared with NPGs, PGs also reported more recent sexual partners. CONCLUSIONS: These data suggest that PG is common in marijuana-abusing youths and that they have increased psychosocial problems. These data suggest the need for early identification and treatment of PG in substance-abusing adolescents.

Nutrient intake and risk of subtypes of esophageal and gastric cancer.

Incidence rates for adenocarcinoma of the esophagus and gastric cardia have been rising rapidly. We examined nutrient intake as a risk factor for esophageal and gastric cancers in a population-based case-control study in Connecticut, New Jersey, and western Washington state. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma (n = 282), adenocarcinoma of the gastric cardia (n = 255), esophageal squamous cell carcinoma (n = 206), and noncardia gastric adenocarcinoma (n = 352), along with population controls (n = 687). Associations between nutrient intake and risk of cancer were estimated by adjusted odds ratios (ORs), comparing the 75th versus the 25th percentile of intake. The following nutrients were significantly inversely associated with risk of all four tumor types: fiber, beta-carotene, folate, and vitamins C and B6. In contrast, dietary cholesterol, animal protein, and vitamin B12 were significantly positively associated with risk of all four tumor types. Dietary fat [OR, 2.18; 95% confidence interval (CI), 1.27-3.76] was significantly associated with risk of esophageal adenocarcinoma only. Dietary nitrite (OR, 1.65; 95% CI, 1.26-2.16) was associated with noncardia gastric cancer only. Vitamin C supplement use was associated with a significantly lower risk for noncardia gastric cancer (OR, 0.60; 95% CI, 0.41-0.88). Higher intake of nutrients found primarily in plant-based foods was associated with a reduced risk of adenocarcinomas of the esophagus and gastric cardia, whereas higher intake of nutrients found primarily in foods of animal origin was associated with an increased risk.

Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional.

BACKGROUND: Few studies have evaluated the impact of specific fluoride sources on the prevalence of enamel fluorosis in the population. The author conducted research to determine attributable risk percent estimates for mild-to-moderate enamel fluorosis in two populations of middle-school-aged children. METHODS: The author recruited two groups of children 10 to 14 years of age. One group of 429 had grown up in nonfluoridated communities; the other group of 234 had grown up in optimally fluoridated communities. Trained examiners measured enamel fluorosis using the Fluorosis Risk Index and measured early childhood fluoride exposure using a questionnaire completed by the parent. The author then calculated attributable risk percent estimates, or the proportion of cases of mild-to-moderate enamel fluorosis associated with exposure to specific early fluoride sources, based on logistic regression models. RESULTS: In the nonfluoridated study sample, sixty-five percent of the enamel fluorosis cases were attributed to fluoride supplementation under the pre-1994 protocol. An additional 34 percent were explained by the children having brushed more than once per day during the first two years of life. In the optimally fluoridated study sample, 68 percent of the enamel fluorosis cases were explained by the children using more than a pea-sized amount of toothpaste during the first year of life, 13 percent by having been inappropriately given a fluoride supplement, and 9 percent by the use of infant formula in the form of a powdered concentrate. CONCLUSIONS: Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation under the pre-1994 protocol and early toothbrushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early toothbrushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate. CLINICAL IMPLICATIONS: By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.

Adult lead poisoning from an Asian remedy for menstrual cramps--Connecticut, 1997.

Follow-back procedures to determine the source of elevated blood lead levels (BLLs) are integral parts of the CDC's National Institute for Occupational Safety and Health Adult Blood Lead Epidemiology and Surveillance program (ABLES) in 27 states. Although an estimated 90%-95% of cases of elevated BLLs reported to the states in the ABLES program result from occupational exposures, nonoccupational exposures also are identified by this system. This report describes a case of adult lead poisoning attributed to an Asian remedy for menstrual cramps, "Koo Sar" pills, following an investigation by the Adult Lead Registry of the Connecticut Department of Public Health (CDPH), Division of Environmental Epidemiology and Occupational Health.

Home-based therapies for the common cold among European American and ethnic minority families: the interface between alternative/complementary and folk medicine.

BACKGROUND: Most studies of alternative/complementary medicine use in children have focused on children with chronic illness and have not addressed the more common form of complementary medicine: popular home-based interventions and therapies for common low-morbidity sickness episodes. Also, there has often been a distinction between alternative/ complementary medical practices used by the general population and those used by members of ethnic minority groups and commonly referred to as folk medicine or ethnomedicine. OBJECTIVE: To describe the home-based therapies and practices that parents from diverse ethnocultural backgrounds use to treat the common cold in their children. METHOD: Interviews with mothers of children coming for care at a number of clinics and physicians' offices. Included were mothers from European American, African American, Puerto Rican, and West Indian-Caribbean heritages. RESULTS: Mean number of home-based remedies for the common cold did not differ among ethnic groups (controlling for maternal age, maternal education, number of children, and health insurance status). There were differences among groups regarding the frequency of use of specific remedies. CONCLUSIONS: Home-based remedies for colds in childhood are commonly used. Many of the treatments are complementary to biomedical treatment (ie, antipyretics, over-the-counter cold remedies, fluids). Very few are potentially hazardous if taken in moderation. Mothers from ethnic minorities use similar amounts of homebased interventions when compared with mothers from the majority culture.