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J R Sugarman

Publications and source records attributed to J R Sugarman.

34 records · Page 2Linked to original sources
PubMed1990

Evidence for a secular change in obesity, height, and weight among Navajo Indian schoolchildren.

A survey measuring heights and weights of 1969 schoolchildren residing on the Navajo Indian Reservation was conducted in 1989. The findings were compared with National Center for Health Statistics (NCHS) reference data and with surveys of Navajo children from 1955, 1968, and 1981. Approximately twice as many children exceeded the 95th percentile of weight-for-age (11.2% of girls, 12.5% of boys) than would be expected for the NCHS reference population. The mean weight-for-height z scores exceeded those for the NCHS reference population for all ages in both sexes. Compared with data from 1955, mean heights increased 6.1% among boys and 4.4% among girls whereas mean weights increased 28.8% among boys and 18.7% among girls across all age groups. The data suggest that there has been a secular change in height, weight, and obesity in Navajo Indian children over the past 35 y.

Adolescent↗
PubMed1990

The changing epidemiology of diabetes mellitus among Navajo Indians.

Although early descriptions of diabetes mellitus among Navajo Indians characterized the disease as an infrequent and "benign chemical abnormality," the prevalence of diabetes and its complications among Navajos appears to have increased substantially in this century. We reviewed recent Indian Health Service inpatient and ambulatory care data and compared these data with previous reports. Of the estimated Navajo population aged 45 years or older, 4,331 (16.9%) had an ambulatory care visit for diabetes between October 1, 1986, and September 30, 1987. Diabetes was coded for 1,041 (7.0%) of hospital admissions of persons aged 20 and older. Of 377 lower-extremity amputations done from 1978 to 1987, diabetes was involved in 245 (66%). The 1986 age-adjusted mortality rate from diabetes was 30.3 per 100,000, approximately twice that for the general US population. The explanation for the increased prevalence of diabetes mellitus among Navajos probably relates to an increasing prevalence of obesity.

Adult↗
PubMed1990

Prevalence of diagnosed hypertension among diabetic Navajo Indians.

Hypertension is more common among persons with non-insulin-dependent diabetes mellitus than among appropriately matched nondiabetic populations. The presence of hypertension in persons with non-insulin-dependent diabetes mellitus is associated with increased rates of the microvascular and macrovascular complications of non-insulin-dependent diabetes mellitus. A cross-sectional study of a cohort of 817 diabetic Navajo Indians was performed to determine the age-, sex-, and duration-specific prevalence of diagnosed hypertension. Persons with end-stage renal disease were excluded from the population. A total of 388 of the patients (47.5%) had diagnosed hypertension. The prevalence of hypertension increased with increasing age. Contrary to findings in other populations, women did not have higher rates of hypertension than men. The duration of diabetes did not have a consistent effect on the rates of hypertension. The current prevalence of hypertension among Navajos with diabetes is higher than that reported two decades ago.

Adult↗
PubMed1989

Prevalence of gestational diabetes in a Navajo Indian community.

A retrospective analysis of 4,094 deliveries among Navajo Indian women was carried out to determine the prevalence of gestational diabetes mellitus and diabetes antedating pregnancy. Three data sources--a local prenatal registry, a delivery room log, and hospital discharge records--were evaluated for their usefulness as surveillance systems for gestational diabetes. In all, 177 cases of gestational diabetes and 13 cases of preexisting diabetes were identified, giving a prevalence of maternal diabetes in pregnancy of 4.6%. When women with preexisting diabetes or documented gestational diabetes during a previous pregnancy were excluded, the prevalence of gestational diabetes during the study period was 3.4%. Although each data source used separately failed to identify 20% to 40% of diabetic pregnancies, more than 97% of cases were identified using a combination of the prenatal registry and the delivery log.

Adult↗
PubMed1984

Management of lithium intoxication.

Lithium toxicity is usually insidious in onset and presents with a wide spectrum of clinical symptoms. Symptoms vary from mild lethargy to seizures and coma. Although mild to moderate intoxication can be managed with intravenous saline, cases not responding or severe cases should be treated by hemodialysis. Iatrogenic fluid and electrolyte disorders often complicate therapy.

Adult↗
PubMed1984

Evaluation of fatigue in a family practice.

A retrospective chart review describing the rates of occurrence, methods of evaluation, and diagnoses of patients complaining of fatigue in a university family medicine teaching practice was performed. After excluding patients in whom an unequivocal explanation for the fatigue was reached at the initial encounter, 118 patients aged 15 years and over were identified during a two-year study in a practice with about 6,000 active adult patients (9.9/1,000 patients per year). The age and sex distributions of the cases were identical to those of the active patient population. The average laboratory examination cost approximately $48. An average of 2.7 laboratory tests per patient were ordered. Although 12 percent of laboratory tests were abnormal, laboratory tests were important in securing a diagnosis in only 9 of the 118 patients. Clinical diagnoses were classified as either primarily biomedical or primarily psychosocial. Psychosocial diagnoses were identified in 50 percent of patients, while primarily biomedical diagnoses were found in 22 percent. No diagnosis was made in 28 percent of patients. Sixty-eight percent of patients had at least one follow-up visit. Failure to follow up was uncommon in patients with depression or biomedical diagnoses other than viral syndromes but was common with other primarily psychosocial diagnoses.

Adolescent↗
PubMed1982

Naltrexone-induced opiate receptor supersensitivity.

Chronic administration of the long-lived narcotic antagonist naltrexone resulted in a marked increase in brain opiate receptors. Similar changes in receptor density were observed for binding of the putative mu agonist [3H]dihydromorphine, the mu antagonist [3H]naloxone, the putative delta ligand [3H]D-Ala2,D-Leu5-enkephalin and [3H]etorphine. In addition, the sensitivity of agonist binding to guanyl nucleotide inhibition increased significantly. In contrast, no such changes in opiate binding were observed following acute administration of naltrexone. The increase in opiate receptor number following chronic naltrexone was highest in the mesolimbic and frontal cortex areas, and lowest in the dorsal hippocampus and periaqueductal gray. These results indicate a degree of plasticity in the opiate receptor system that may correlate with specific functional pathways.

Animals↗
PubMedDate not supplied

Implications for clinical performance measurement of interlaboratory variability in methods for glycosylated hemoglobin testing.

In order to evaluate interlaboratory variation in glycosylated hemoglobin (GHb) testing in the context of quality assessment and performance measurement systems, we conducted a telephone survey of laboratories in Washington state. The survey focused on GHb testing methods, analytes measured, reference ranges, awareness of and adherence to the National Glycohemoglobin Standardization Program (NGSP) standards, and recent changes in methods. We contacted 30 (81%) of 37 laboratories known to conduct GHb testing. Among the 25 laboratories using 1 or more test methods in-house, 5 (20%) reported only total GHb levels rather than HbA1C. There was considerable variability in test methods used and in reported high and low reference ranges within and across methods. Eight (30%) of 27 individual methods used by the laboratories were not certified by the NGSP. From January 1997 through August 1998, 11 of 25 laboratories (44%) made changes in testing methods. Despite national efforts to decrease variability in GHb testing methods, substantial variability remained in Washington state in 1997. In addition to hindering management of individual patients, this variability poses challenges for clinical performance measurement systems such as the Health Plan and Employer Data Information Set that attempt to compare the adequacy of glycemic control among health systems. However, the high frequency of recent changes in testing methods may indicate an improving trend in test methods.

Clinical Laboratory Techniques↗
PubMedDate not supplied

Using the Behavioral Risk Factor Surveillance System to monitor year 2000 objectives among American Indians.

The Behavioral Risk Factor Surveillance System, a data set based on telephone surveys that have been conducted by States in collaboration with the Centers for Disease Control, has been used to estimate the prevalence of behavioral risk factors for adults in the United States so health objectives can be set and progress towards accomplishing them measured. Data for adult American Indians in this regard have not been available generally. The use of these data to estimate behavioral risk prevalence for American Indians by geographic region was examined and the results compared with those for white Americans. In addition, data from the system were compared with other data sets, including the results of selected surveys in American Indian communities, to explore the validity of the system as a tool for evaluating the behavioral risks of Indians. Behavioral Risk Factor Surveillance System data for the period 1985 to 1988 were used. During this period, the 1,055 American Indian respondents constituted 0.63 percent of those responding under the system and 0.70 percent of the population of the participating States. Separate (sex-specific) behavioral risk prevalence estimates were derived for Indians and whites for four geographic regions--Southwest, Plains, West Coast, and Other States. The system's behavioral risk estimates for the Plains region were compared with available data from behavioral risk surveys done in three American Indian communities in Montana (Blackfeet, Fort Peck, and Great Falls) from 1987 to 1989. The behavioral risk factors compared include use of automobile seatbelts, current smoking, current use of smokeless tobacco, heavy drinking, drinking and driving, overweight, hypertension, and sedentary lifestyle. Although large regional differences in the prevalence of these risk factors were found, the magnitude and direction of the differences are frequently similar among American Indians and whites living in the same geographic regions. The findings from the Behavioral Risk Factor Surveillance System among American Indians are largely consistent within dependently collected data from more resource intensive household surveys, at least when surveys in Montana are compared with system data from the Plains. These data are generally consistent with other epidemiologic studies.When they are used in conjunction with community-specific surveys, the Behavioral Risk Factor Surveillance System data may be useful for monitoring the progress of American Indians towards the Year 2000 national health objectives. The value of the surveillance system for monitoring trends in behavioral risk factors among Indians would be enhanced if States attempted to over sample regions (such as Indian reservations) with a high proportion of Indian residents. It appears that aggressive health promotion and disease prevention efforts will be needed if these objectives are to be achieved.

Adolescent↗
PubMedDate not supplied

Serum cholesterol concentrations among Navajo Indians.

Navajo Indians have been reported by earlier investigators to have low concentrations of serum lipids and a low prevalence of hyperlipidemia, as well as low rates of ischemic heart disease. However, no data on serum lipid concentrations among Navajos have been reported for more than two decades. The authors conducted a study to determine the distribution of concentrations of serum total cholesterol (TC), high density lipoprotein cholesterol, low density lipoprotein cholesterol, and triglyceride among persons 25-74 years old living in a representative community on the Navajo Indian reservation. Data are reported for 255 subjects, 105 men and 150 women, ages 25-74 years. The authors compared these data to those for the general population as determined by the second National Health and Nutrition Examination Survey (NHANES II). TC concentrations among Navajo men were similar to those from NHANES II. TC concentrations among younger Navajo women were similar to those for women younger than 55 years from NHANES II, but were significantly lower among older Navajo women. While 27.6 percent of men ages 25-74 years studied in NHANES II had TC concentrations greater than 240 milligrams per deciliter, 33.8 percent of Navajo men had similarly elevated TC. However, the prevalence of serum TC concentrations greater than 240 milligrams per deciliter among Navajo women (17.5 percent) was about half that among women studied in NHANES II (32.9 percent). A similar pattern was found for low density lipoprotein cholesterol. The researchers concluded that Navajo Indians are no longer characterized by low serum lipid concentrations, that increased cholesterol concentrations may be a harbinger of increasing rates of atherosclerotic coronary heart disease among Navajos, and that attention should be directed to primary prevention of hyperlipidemia in Navajo Indian communities.

Adult↗
PubMedDate not supplied

Abnormal Papanicolaou smears and colposcopic follow-up among American Indian and Alaska Native women in the Pacific northwest.

BACKGROUND: Mortality that is due to cervical cancer among American Indian and Alaska Native women in the Pacific Northwest exceeds that among women of other races. Nevertheless, little information is available regarding the prevalence and follow-up of abnormal Papanicolaou smears among American Indian and Alaska Native women in the region. METHODS: We conducted a retrospective review of medical records of American Indian and Alaska Native women seen at 12 Indian Health Service and tribally operated clinics in Washington, Oregon, and Idaho who had an abnormal Papanicolaou smear in 1992. RESULTS: Of 4547 Papanicolaou smear results reviewed, 280 (6.2 percent) had an abnormal result (dysplasia or carcinoma in situ). Of the recommended colposcopies, 167 of 224 (75 percent) were completed. Women with high-grade squamous intraepithelial lesions were more likely to obtain recommended colposcopy than were women with low-grade squamous intraepithelial lesions. Women treated at clinics that referred patients to outside providers for colposcopy were more likely to have colposcopy than were those who were offered the procedure on site. CONCLUSIONS: The proportion of Pacific Northwest American Indian and Alaska Native women in Indian Health Service and tribal clinics with abnormal Papanicolaou smears and the proportion who receive colposcopy are similar to those in other populations. The higher rate of cervical cancer mortality among American Indian and Alaska Native women could be due to failure to screen high-risk women. Cytologic screening rates, methods to improve adherence to colposcopy recommendations, and the contribution of other factors to the cause of cervical cancer mortality need to be characterized in this population.

Alaska↗
PubMedDate not supplied

Prevalence of risk factors for residential fire and burn injuries in an American Indian community.

Fatality rates from residential fires are high among American Indians. Contact burns and scalds are also among the leading types of thermal injuries. Information about the prevalence of risk factors for burn injuries is required to design interventions aimed at reducing residential fire and burn injuries. The authors conducted a survey in July and August 1992 of 68 households located in a small American Indian community in Washington State to ascertain the prevalence of selected risk factors for residential fire and burn injuries. Nearly all households (96 percent) in the study had a smoke detector, and 95 percent of those tested were functioning. However, a high prevalence of other household characteristics associated with excess risk of residential fire and burn injuries was identified: 59 percent of households had at least one member who smoked, 25 percent had a member who smoked in bed, 38 percent had a member who drank alcohol and smoked at the same time, 46 percent used wood stoves as a heat source, and 15 percent of households were mobile homes. Thirteen percent of households had at least one fire during the previous 3 years, and the incidence of burns due to all causes and requiring medical treatment was 1.5 per 100 persons per year. Hot water temperature was measured to determine the potential risk for scald burns, and 48 percent of households had a maximum hot water temperature of 130 degrees or more Fahrenheit. Such surveys can guide intervention strategies to reduce residential fire and burn injuries in American Indian communities.

Adolescent↗
PubMedDate not supplied

The urban American Indian oversample in the 1988 National Maternal and Infant Health Survey.

Although more than two-thirds of American Indians and Alaska Natives (AI) live outside reservations and Tribal lands, few data sets describe social and maternal-child health risk factors among urban AI. The Indian Health Service sponsored a special effort to survey mothers of AI infants as part of the 1988 National Maternal and Infant Health Survey (NMIHS), a comprehensive national study conducted by the National Center for Health Statistics, Centers for Disease Control. The authors analyzed questionnaires completed by mothers residing in selected locations served by urban Indian health programs and compared the data with those for women of other races residing in metropolitan areas. After adjusting the sample for non participating States, the response rate in the Urban Indian Over sample was 60.8 percent (763 of 1,254). More than 45 percent of AI and black respondents, compared with 15 percent of white respondents, reported an annual household income of less than $10,000. About half of AI and black women, compared with nearly three-quarters of white women, reported having insurance or health maintenance organization coverage during pregnancy. Despite having a similarly low rate of health insurance coverage and low household income, AI respondents were far less likely than black respondents to have Medicaid coverage. A higher proportion of AI women than of black or white women reported difficulties in obtaining prenatal care, and AI women were less likely to obtain prenatal care. AI women were also less likely than white women to obtain prenatal care in the first trimester. Although a similar proportion of Al and white women reported that they consumed alcohol during the year before pregnancy, a higher proportion of Al drinkers than of white drinkers reported consuming one or more drinks weekly after finding out they were pregnant. The proportion of unwanted pregnancies was higher among Al women than among white women, but lower than among black women. Al and black women had a higher prevalence of depressive symptoms than did white women.The data suggest that urban Al mothers experience a disproportionate burden of economic, social, and behavioral risk factors for adverse pregnancy outcome.In spite of some data limitations, the Urban Indian Over sample of the NMIHS provides important information about social and health risk factors among urban Al mothers.

Adult↗
PubMedDate not supplied

Trauma among American Indians in an urban county.

OBJECTIVE: To describe severe injury among American Indians in a large metropolitan county given that most previous studies of the high Indian injury morbidity and mortality rates have been conducted primarily in rural areas. METHODS: A retrospective analysis of a hospital trauma registry was conducted for the years 1986-92 at the Harborview Medical Center, the only Level I trauma center in King County, Washington, metropolitan county with the seventh largest number of urban American Indians in the United States. RESULTS: Of 14,851 King County residents included in the registry, 593 (4%) were classified as American Indian. With King County whites as the reference, the age-standardized incidence ratio for inclusion of American Indians in the registry was 4.4 (95% confidence interval 4.1, 4.8). The standardized incidence ratios and proportional incidence ratios showed significant differences in mechanism and whether it was intentional or unintentional among Indians compared with whites. Hospitalizations for stab wounds, bites, and other blunt trauma were all significantly more frequent among Indians. Trauma admissions among Indians were disproportionately associated with assaults. A high proportion (72.3%) of American Indians tested had blood alcohol levels exceeding 0.1%. CONCLUSION: Urban American Indians experience high rates of trauma, differing from those among whites. Efforts to reduce injury in urban areas should include collaboration with representative urban American Indian organizations.

Adolescent↗