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Biomedical subjects

S D Helgerson

Publications and source records attributed to S D Helgerson.

At least 37 records · Page 2Linked to original sources
PubMed1993

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES: This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS: Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS: Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS: This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.

Alaska↗
PubMed1993

Prevalence of diagnosed diabetes among American Indians and Alaska Natives, 1987. Estimates from a national outpatient data base.

OBJECTIVE: To estimate the prevalence of diagnosed diabetes among American Indians and Alaska Natives served by the IHS. RESEARCH DESIGN AND METHODS: This was a cross-sectional study of the 1987 IHS national outpatient data base. RESULTS: Prevalence rates of diagnosed diabetes determined from the IHS outpatient data base were consistent with recent studies of diabetes in different IHS areas. IHS-wide, age-adjusted prevalence was 69/100,000, or 2.8 times the U.S. rate. There was considerable variation in prevalence rates of diabetes throughout the country, with rates ranging from 15.3/100,000 in Alaska to 119.2/100,000 in southern Arizona. CONCLUSIONS: This study documented the high prevalence of diabetes among American Indians and Alaska Natives and the wide variation in rates between different tribal groups. This study also demonstrated the feasibility of using an outpatient data base to estimate rates of disease that have uniform methods of diagnosis and result in frequent clinic visits.

Age Factors↗
PubMed1993

Prevalence and risk factors for diabetes and diabetes-related amputations in American Indians in southern Arizona.

OBJECTIVE: To describe the prevalence of NIDDM and LEA using data from a computer-based patient data base. RESEARCH DESIGN AND METHODS: Diabetic patients with and without LEA, and nondiabetic patients were identified by computer search. Charts of diabetic patients were reviewed for confirmation of diagnosis of diabetes and diabetes-related amputation. The diabetic and nondiabetic populations were described, and certain risk factors were identified. RESULTS: The overall prevalence of NIDDM in this tribe in 1985-1986 was 18.3/100 adults (> or = 18 yr of age), whereas the prevalence of LEA/100 adults with NIDDM was 10.3%. Females were 1.3 times as likely to have diagnosed diabetes as males (95% CI 1.2-1.4), and males with diabetes were 1.4 times more likely to have had LEA than females with diabetes (95% CI 1.1-1.9). CONCLUSIONS: Automated health-care delivery data base used for this tribe can be used to maintain surveillance for diabetes and amputations in diabetic patients. Effective programs to prevent complications of diabetes, such as LEA, in this tribe are urgently needed.

Adolescent↗
PubMed1992

Cancer incidence and survival among American Indians registered for Indian health service care in Montana, 1982-1987.

BACKGROUND: Cancer incidence and cancer survival estimates in American Indians are quite limited. PURPOSE: Our purpose was to estimate cancer incidence and survival in American Indians who were registered for Indian Health Service (IHS) care in Montana. METHODS: We linked databases from the IHS and the Montana Central Tumor Registry (MCTR) to ascertain cases for the time period from January 1, 1982, through December 31, 1987. To calculate survival rates, we used a relative survival method that incorporated age-specific risks for noncancer deaths among American Indians. RESULTS: We identified 344 cases that were compatible with the National Cancer Institute (Surveillance, Epidemiology, and End Results Program) surveillance definition of cancer. Of these cases, 249 (72%) were listed in both the MCTR and the IHS databases; 56 (16%) and 39 (11%) were listed in only the MCTR or the IHS database, respectively. Compared with the overall cancer incidence in U.S. White men, the overall cancer incidence in Montana American Indian men was markedly lower, as was the incidence for colorectal and bladder cancers and for non-Hodgkin's lymphoma. The overall cancer incidence for Montana American Indian women differed less markedly, however, from the overall incidence in U.S. White women. Compared with the cancer incidence in U.S. White women, the incidence in Montana American Indian women was significantly higher for cervical cancer but was significantly lower for colorectal, breast, and uterine cancers. Survival rates from cancer were also examined for the first time in this population. For those sites examined, the survival rates were much lower in Montana American Indians than in U.S. Whites. CONCLUSIONS: We conclude that it is feasible to develop state-specific cancer incidence and survival estimates for American Indians in at least some states in different regions of the United States. Collaboration between the IHS and a state tumor registry is likely to improve the case ascertainment achieved by either agency alone.

Female↗
PubMed1992

HIV infection in American Indians and Alaska Natives: surveys in the Indian Health Service.

A network of surveys of HIV seroprevalence in American Indians and Alaska Natives (AI/AN) was begun in 1989. From July 1, 1989 through June 30, 1991, 37,681 serologic specimens were collected from prenatal and sexually transmitted disease patients in 58 facilities operated or funded by the Indian Health Service. Specimens from AI/AN women receiving initial prenatal care showed an overall HIV prevalence of 0.3/1,000, while specimens obtained during the third trimester of pregnancy showed an overall prevalence of 1.0/1,000. The rate for rural third trimester prenatal patients (0.9/1,000) was similar to that for urban patients (1.1/1,000). HIV rates among third trimester AI/AN patients in three western states were 4 to 8 times higher than rates observed in childbearing women of all races in those states. The overall HIV seroprevalence in AI/AN seeking care for sexually transmitted diseases was 4.5/1,000 for males (urban 10.8/1,000; rural 2.0/1,000) and 0.7/1,000 for females (urban 0.9/1,000; rural 0.6/1,000). Approximately 1,210 to 4,250 (midpoint of range = 2,730) AI/AN in the U.S. are projected from survey findings to be currently infected with HIV. The presence of HIV in multiple specimens from rural areas and the similarity of HIV infection rates for female patients from rural and urban locations provides evidence of diffusion of the HIV epidemic to rural AI/AN, and emphasizes the need for effective HIV prevention for this population.

Adolescent↗
PubMed1991

Evaluation of the effect of school-based education on adolescents' AIDS knowledge and attitudes.

To measure the effect of school-based education on adolescents' AIDS knowledge and attitudes, we conducted surveys in two high schools and compared them to a baseline survey conducted in the same schools the previous year. One month before the follow-up survey, students in one of the two schools (the intervention school) had received a two-day education program about AIDS; students in the other (control) school had received no specific AIDS education. Students in both schools showed increases in AIDS knowledge between the baseline and follow-up surveys. Students in the intervention school were more likely than students in the control school to answer questions correctly about the safety of blood donation (82% vs 73%) and the possibility of HIV transmission from a former intravenous drug user (85% vs 67%); they were also less likely than students in the control school to believe persons with AIDS should have certain restriction on their activities. We conclude that while students' level of knowledge about AIDS and HIV has been improving over time even without intervention, specific education programs can still transmit important information, including information that is necessary to prevent or change risky behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Influenza outbreaks in nursing homes: how effective is influenza vaccine in the institutionalized elderly?

During the 1984-1985 influenza season, outbreaks of influenza A (H3N2) occurred in three Connecticut nursing homes. Influenza vaccination rates were 67% (96 out of 144), 35% (30 out of 85) and 69% (332 out of 483), respectively. The relative risk of illness for vaccinated compared to unvaccinated residents was 1.8 (95% confidence interval, 0.6, 5.9), 1.6 (95% confidence interval, 0.8, 3.0) and 1.1 (95% confidence interval, 0.8, 1.7) for each of the three nursing homes, respectively. In the third outbreak, 22 vaccinated residents without clinical illness had a geometric mean titer of hemagglutination-inhibition (HI) antibody of 20. Although low, this titer was significantly higher than that of nine unvaccinated residents without clinical illness (12, p less than .05); only three (14%) vaccinated residents had HI titers of greater than or equal to 40. These results suggest that levels of HI antibody in vaccinated residents were not protective at the time of the third outbreak, four to five months after vaccination. In general, the study of vaccine effectiveness in nursing homes is limited by sample size and statistical power. Despite these limits, the retrospective investigation of influenza outbreaks in nursing homes is often the only practical way to evaluate influenza vaccine effectiveness in the elderly on a yearly basis.

Adult↗
PubMed1990

Neuropathy in Navajo children: clinical and epidemiologic features.

We describe a rare and apparently unique neuropathic syndrome among Navajo children living on the Navajo Reservation. Clinical features include sensorimotor neuropathy, corneal ulcerations, acral mutilation, poor weight gain, short stature, sexual infantilism, serious systemic infections, and liver derangement including Reye's syndrome-like episodes. Progressive CNS white matter lesions were diagnosed through magnetic resonance imaging. We identified 20 definite and 4 probable cases occurring between 1959 and 1986. Mean age at the time of 1st recognized symptom was 13 months (range, 1 month to 4 years 6 months). Ten individuals have died; 6 of the deaths occurred before 5 years of age. The incidence of this syndrome on the western Navajo reservation is 5 times higher than that on the eastern reservation (38 compared with 7 cases per 100,000 births). Although the etiology is unknown, this syndrome is consistent with an inborn error of metabolism, inherited in an autosomal recessive manner.

Adolescent↗
PubMed1990

End state renal disease among Native Americans, 1983-86.

We used data reported to Medicare from 1983 through 1986 to determine the incidence of end-stage renal disease (ESRD) among Native Americans and Whites in the United States. The 1,075 Native American cases represented an annual incidence, age-adjusted to the White population, of 269 per million, 2.8 times the rate for Whites. Fifty-six percent of Native American cases and 27 percent of the White cases were attributed to diabetes, indicating that ESRD is a major problem. Diabetes control provides the greatest opportunity for prevention.

Adolescent↗
PubMed1988

Immunization coverage of children in a semi-urban village panchayat in Nepal, 1985.

This research project, funded by the Yale International Committee and in cooperation with UNICEF, Nepal, used a questionnaire to survey and assess the immunization status of children 3 years or younger in a semi-urban panchayat. Mothers of children ranging in age from less than 1 month to 3 years were questioned both about immunization status of their children and their own use of health care and specific sources of information. 54% (124/228) of the children had received at least one vaccine and only 4% (10/228) had full coverage with the recommended vaccines (3 doses of DPT and TOPV, one dose of measles and BCG). The mean number of vaccinations for males was significantly greater than that for females (2.12 vs 1.39, P = 0.007, t = 2.80). Male children were twice as likely to have received vaccines as females (76/122, 62% vs 48/106, 45%; Odds Ratio = 2.00). Children born at a hospital were more likely than those born at home to have been vaccinated (23/34, 68% vs 101/194, 52%; P = 0.05, chi 2 = 12.52, d.f. = 2). Most mothers obtained health information from neighbors (38%), radio (22%), or health workers (18%), and 85% of the children were born at home; the majority (164/228, 72%) of the women received assistance during childbirth, 28% of the total reported self delivery. More than 70% of the women felt that vaccinations were good preventive measures. The study results suggest that health education about immunization efforts should be focused on women and these efforts should be intensified.

Child, Preschool↗
PubMed1988

Community health effects of a municipal water supply hyperfluoridation accident.

For 12 hours, excess hydrofluorosilicic acid was diverted to a 127-home community water supply. Fluoride levels peaked at 51 parts per million (ppm). Water acidification caused copper to leach from the domestic plumbing; raising copper levels to 25-41 ppm. Fifty-two (33 per cent) of those who drank hyperfluoridated water developed mild gastroenteritis. Vomiting was uncommon and symptom onsets usually occurred greater than 30 minutes after drinking water; suggesting that fluoride, rather than copper, caused illness. Skin contact with hyperfluoridated water caused itching and skin rashes.

Accidents, Occupational↗
PubMed1988

Acquired immunodeficiency syndrome and secondary school students: their knowledge is limited and they want to learn more.

Information was gathered from 657 junior high school and senior high school students in two Connecticut school districts regarding their knowledge of acquired immunodeficiency syndrome (AIDS). Although many students had some factual knowledge about the virus that causes AIDS, many students were misinformed about methods of viral transmission, high-risk groups for acquiring AIDS, and methods to avoid acquisition of the virus. Most students did not recognize the existence of a carrier state. Responses from students of different grades, ages, sexes, races, and school districts differed rarely and without apparent pattern. Students reported that they had learned about AIDS mostly from television or radio (57%) or magazines or newspapers (16%); few had learned from persons with whom they had frequent contact, such as parents (6%) or teachers (4%). Seventy-four percent of students said they wanted to learn more about AIDS, and 49% said they wanted to learn it in school. Results of this study indicated that students' knowledge about AIDS is not adequate, students wish to learn more, and information about AIDS should be presented in public schools.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Intestinal myiasis in a baby attending a public health clinic.

This article describes a case of intestinal myiasis--the presence of fly larvae in the intestines--in a 12-month-old baby. The asymptomatic child was twice treated by her physician for a presumptive diagnosis of pinworm infection. The mother continued to see "worms" in the child's stool and brought her to a public health primary care clinic where she was evaluated by nurse practitioners. Larvae (maggots) of the false stable fly, Muscina stabulans, were identified in each of two stool specimens collected on different days. Examination of stool specimens from other family members showed no larvae. The likely source of the child's infection was over-ripened bananas, which were kept in a hanging basket. No pharmacologic treatment was prescribed, but the parents were instructed to cover the fruit and wash it before consumption. Nurse practitioners are encouraged to report suspected cases of myiasis and to work with patients, their families and public health personnel in order to confirm the diagnosis, identify the source and make suggestions to prevent further infestation.

Ambulatory Care Facilities↗
PubMed1986

Methicillin-resistant Staphylococcus aureus: how reliable is laboratory reporting?

Microbiology laboratories in Oregon were surveyed in 1981 to determine how often methicillin-resistant Staphylococcus aureus (MRSA) was being reported to physicians in the state. Results of this survey were surprising in three respects. First, the mean percent of S. aureus isolates reported by laboratories as methicillin-resistant was 8.3%. Second, a significant inverse correlation was found between the percent of reported MRSA and laboratory size (p = 0.0001). Finally, laboratories which retested initially resistant isolates reported significantly less MRSA (mean 3.3%, median 1%) than those laboratories which accepted initial results (mean 20%, median 12%) (p = 0.0001). Independent testing by the Centers for Disease Control of isolates reported to be MRSA confirmed that some misidentification was occurring. Participating laboratories were notified of our initial findings and their potentially serious clinical ramifications. Laboratories were resurveyed in 1982, and a significant decrease in the reported MRSA to a mean percentage of 3.4% was observed (p = 0.002). It is unlikely that this situation is unique to Oregon, and similar misreporting of MRSA to physicians in other areas of the country may be compromising the safe and effective treatment of S. aureus infections.

Health Surveys↗
PubMed1986

Control of day care shigellosis: a trial of convalescent day care in isolation.

Simultaneous outbreaks of S. sonnei infections occurred in September 1983 at two day care centers in Seattle, Washington. At both centers, there were high rates of diarrheal illness in the children (22/80 and 11/23, respectively), in staff members, and in family members of the ill children. The smaller center was temporarily closed, but the larger one remained open. Convalescent children and staff whose diarrhea had resolved and who were receiving appropriate antimicrobials were allowed to return to the larger center before negative cultures were obtained and were separated in an isolation room. No culture-proven cases of shigellosis occurred at either center in the following two months. Plasmid profile determinations suggested the Shigella were not transmitted from the center that remained open to the community. Estimated need for alternate child care requirements at the closed center were 100-fold greater than at the center with the isolation room. Caring for convalescent children in isolation at day care centers while they receive antimicrobial therapy may be a useful strategy for controlling day care shigellosis.

Adult↗