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Biomedical subjects

S D Helgerson

Publications and source records attributed to S D Helgerson.

At least 55 records · Page 3Linked to original sources
PubMed1986

Diarrhea associated with adherent enteropathogenic Escherichia coli in an infant and toddler center, Seattle, Washington.

During November 1983, the Seattle-King County Department of Public Health investigated an outbreak of diarrhea associated with enteropathogenic Escherichia coli, serogroup 0111:K58, in an infant and toddler day-care center. Of the 25 children in the center, ranging in age from 4 to 30 months (median age 11 months), diarrhea occurred in 14 characterized by watery, greenish stools. The median duration of diarrhea was 12 days. Two of the ill children were hospitalized because of severe dehydration. Stool cultures from the children diagnosed initially did not yield the common bacterial pathogens, parasites, or rotavirus. Stool cultures from 11 of 14 ill children and two of 11 well children (P less than .005), however, yielded an E coli serogroup, 0111:K58, which was not invasive or toxigenic by standard tests. The source of the organism was not identified. Although this organism has been recognized as a cause of diarrhea in newborn nurseries, this is the first published report of a documented outbreak of enteropathogenic E coli-induced diarrhea in a day-care center in the United States.

Child Day Care Centers↗
PubMed1985

Secondary Haemophilus influenzae type b in day-care facilities. Risk factors and prevention.

The risk factors for acquisition of secondary day-care-associated Haemophilus influenzae type b disease were evaluated in a cohort of children in Seattle-King County, Washington; Atlanta; and the state of Oklahoma. During the study period, 129 primary cases were identified in children less than 5 years old who attended day-care facilities. In ten instances (8%), a secondary case occurred between one and 60 days after a primary case in the same classroom. Risk of secondary disease in classroom contacts was strongly age related: 2.4% in children 0 to 11 months old, 1.2% in children 12 to 23 months old, and 0.0% in children 24 to 59 months old. Controlling for age, children attending day-care more hours per week were more likely to transmit or acquire secondary disease. Risk of secondary disease for children in other classrooms at a center where a case had occurred was not significantly greater than risk of primary disease. Administration of rifampin to classroom contacts of a child with invasive H influenzae was effective in preventing secondary cases (95% confidence interval for rifampin efficacy, 47% to 100%). For children 0 to 23 months old not treated with rifampin, risk of secondary disease was 2.7% (95% confidence interval, 1.1% to 4.3%), a risk approaching that reported in household contacts.

Age Factors↗
PubMed1984

Toxic shock syndrome in Oregon. Risk of recurrence.

To define the risk of having a recurrence of toxic shock syndrome, we collected information on 53 cases (42 definite and 11 probable cases) that occurred in Oregon between Jan 1, 1980, and May 30, 1982. For the 777 person-months for which follow-up information was available, only one probable recurrent case of toxic shock syndrome occurred. The low frequency of recurrences may be associated with the high frequency (91%) with which beta-lactamase-resistant antibiotics were used in initial episodes of toxic shock syndrome and with the relatively low proportion (44%) of menstruating women who resumed the use of tampons after their first episode.

Adolescent↗
PubMed1983

Hemorrhagic colitis associated with a rare Escherichia coli serotype.

We investigated two outbreaks of an unusual gastrointestinal illness that affected at least 47 people in Oregon and Michigan in February through March and May through June 1982. The illness was characterized by severe crampy abdominal pain, initially watery diarrhea followed by grossly bloody diarrhea, and little or no fever. It was associated with eating at restaurants belonging to the same fast-food restaurant chain in Oregon (P less than 0.005) and Michigan (P = 0.0005) and with eating any of three sandwiches containing three ingredients in common (beef patty, rehydrated onions, and pickles). Stool cultures did not yield previously recognized pathogens. However, a rare Escherichia coli serotype, O157:H7, that was not invasive or toxigenic by standard tests was isolated from 9 of 12 stools collected within four days of onset of illness in both outbreaks combined, and from a beef patty from a suspected lot of meat in Michigan. The only known previous isolation of this serotype was from a sporadic case of hemorrhagic colitis in 1975. This report describes a clinically distinctive gastrointestinal illness associated with E. coli O157:H7, apparently transmitted by undercooked meat.

Adolescent↗
PubMed1982

Toxic shock syndrome in Oregon: epidemiologic findings.

To ascertain the risk factors associated with toxic shock syndrome in Oregon a retrospective questionnaire was given to 18 patients (cases) and to two sets of age- and sex-matched controls. One set of controls consisted of friends (friend-controls) chosen by each patient. The second set of controls was selected from women attending a family planning clinic (clinic-controls). Patients were more likely to have used Rely (Procter & Gamble) tampons than friend-controls who were tampon users (p less than 0.05). There was no significant difference between cases and friend-controls with respect to birth control methods. There were no significant differences between cases and controls for history of sexually transmitted diseases or vaginal infection, frequently of intercourse, intercourse during menstruation, or frequency of tampon change.

Adolescent↗
PubMed1976

The founding of a Medical Service Bureau in King County, Washington -- 1933.

The events leading to the establishment of the King County Medical Service Corporation, now King County Medical-Blue Shield, were varied and complex. Under pressure, the King County Medical Society redefined its code of ethics, expanded its view of acceptable practice and gave birth to a major provider of prepaid health care services.

Blue Cross Blue Shield Insurance Plans↗
PubMedDate not supplied

Prevention of Haemophilus influenzae type b infections in day care: a public health perspective.

The availability of new data regarding the risk of invasive Haemophilus influenzae type b (Hib) among day care attendees allows the formulation of a practical public health approach to this problem. It is now clear that day care attendees are at significantly increased risk for development of primary invasive Hib disease. While the risk of secondary Hib disease for most is low, risk is substantially increased when young day care attendees are exposed to a primary case to a degree analogous to that of household contacts. Because risk for primary Hib disease is increased among day care attendees, immunization of these children with Hib polysaccharide vaccine is of the highest priority and may be appropriate for children as young as 18 months of age. In light of new data documenting the efficacy of rifampin in prevention of secondary disease, the use of this medication is indicated when unvaccinated day care attendees younger than two years old have had significant contact with a primary case.

Age Factors↗
PubMedDate not supplied

Comparing self-reported measures of diabetes care with similar measures from a chart audit in a well-defined population.

The objective of this study was to compare self-reported measures of diabetes care with measures derived from medical records in a well-defined population. Diabetes measures were collected through a 1997 Behavioral Risk Factor Surveillance System telephone survey of American Indians living on or near 7 Montana reservations (N = 398) and were compared with data collected from charts of a systematic sample of American Indians with diabetes seen in 1997 at Indian Health Service (IHS) facilities. Survey respondents were more likely to report a duration of diabetes > or = 10 years (44 vs 31%), annual dilated retinal exam (75 vs 59%), and an influenza immunization in the past year (73 vs 57%) compared with estimates from the chart audit. Estimates of pneumococcal immunization (88 vs 42%), annual cholesterol screening (86 vs 69%), and overweight, based on body mass index (67 vs 50%), were significantly higher from the chart audit. No significant differences were found between the survey respondents and the chart audit data for annual foot exams (65 vs 61%), annual blood pressure checks (98 vs 93%), high cholesterol (35 vs 41%), and high blood pressure (54 vs 64%). These findings suggest that self-reported data may over and underestimate specific measures of diabetes care.

Adult↗
PubMedDate not supplied

Improving glycemic control: can techniques used in a managed care setting be successfully adapted to a rural fee-for-service practice?

The objective of this work was to improve glycemic control using case management supported by electronic diabetes care monitoring. Information for patients with diagnosed diabetes in a rural community was maintained in the Diabetes Care Monitoring System. In September 1998, counseling and medication management for glycemic control was intensified during individual office visits. And, from September 1998 to February 1999, 2-hour cluster visits modeled after a successful urban program were offered for groups of patients with elevated HbA1c values. The median (and 75th percentile) HbA1c values for the patient population decreased from 8.7% (10.9%) in March 1998 (N = 173) to 7.5% (9.3%) in March 1999 (N = 182) and was maintained at 7.5% (9.1%) through March 2000 (N = 182). Case management, including cluster visits, can be accomplished in a rural physician's office with the support of an electronic diabetes care monitoring system. This intensified approach decreased and sustained the HbA1c level by more than a percentage point for the patient population.

Adolescent↗
PubMedDate not supplied

Direct mail intervention to increase retinal examination rates in Medicare beneficiaries with diabetes.

The objective of this study was to identify the baseline frequency of eye examinations for Medicare beneficiaries with diabetes in Montana and to determine whether a direct mail reminder increased eye examinations. Using Medicare Part A and Medicare Part B claims data, a cohort of Medicare beneficiaries with diabetes was defined. Eye examination claims were identified using billing codes specific for retinal examinations, as well as visits to ophthalmologists and optometrists during which retinal exams were likely to have been performed. A random sample of the identified beneficiaries with diabetes received a letter encouraging regular annual retinal examinations. In the first 3-month period after the mailing, the billed eye examination rate for those to whom letters were sent was 2.2 percentage points greater than the rate for those to whom letters were not sent (19.4% vs 17.2%; relative risk, 1.13; 95% confidence interval, 1.01-1.26). However, 6 months after the letters were sent, there was no longer a significant difference in the rates for these 2 groups (32.9% vs 32.4%; relative risk, 1.02; 95% confidence interval, 0.94-1.10). In this study, direct mail outreach initially influenced the proportion of Medicare beneficiaries receiving an eye examination, but this pattern was not sustained over the 6-month follow-up period.

Aged↗
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

Smoking during pregnancy among northwest Native Americans.

There is little available information on the smoking habits of Native Americans. The authors used data from the Washington State birth certificate to determine the prevalence of smoking during pregnancy among Native American mothers in Washington State. From 1984 through 1988, 39.8 percent of all Native Americans smoked during their pregnancy. Smoking patterns during pregnancy differed markedly between Native Americans and whites according to maternal age and marital status. The smoking prevalence in Native Americans, adjusted for maternal age and marital status, was 1.3 times higher than that found in Washington State white women. This is the first analysis of statewide smoking rates during pregnancy among Native Americans. The birth certificate can serve as a readily accessible and low cost surveillance system for populations such as Native Americans, who are otherwise difficult to study. Smoking intervention programs need to be targeted at Native Americans, and how their smoking patterns differ from those of the general population needs to be recognized.

Adolescent↗
PubMedDate not supplied

Excess infant mortality in an American Indian population, 1940 to 1990.

OBJECTIVE: --To describe the infant mortality experience of an American Indian community and to demonstrate the utility of examining community-level mortality data. DESIGN: --Descriptive, population-based historical review of infant death certificates. SETTING: --The Warm Springs Indian Reservation, Oregon. PATIENTS OR OTHER PARTICIPANTS: --Infant tribal members of the Confederated Tribes of Warm Springs, 1940 to 1990. INTERVENTIONS: --None. MAIN OUTCOME MEASURES: --Categorization of causes of infant deaths and calculations of mortality rates. RESULTS: --The infant mortality rate, while lower in each decade since the 1940s, was still 2.6 times the national (all races) rate in the 1980s. Neonatal deaths did not account for many of the excess deaths. The postneonatal mortality rate has consistently been much greater than the national rate and was five times greater in the 1980s. Almost all of the excess infant mortality since 1980 has been due to the sudden infant death syndrome. CONCLUSIONS: --While there has been a dramatic decrease in infant mortality for this American Indian population, it remains higher than the national rate. Examining the causes of infant death has enabled this population to develop focused strategies to reduce infant mortality.

Cause of Death↗
PubMedDate not supplied

Prevalence of behavioral risk factors in two American Indian populations in Montana.

Despite great improvements in recent decades, the health status of American Indians continues to lag behind that of other Americans. Continued health improvement will depend largely on changes in individual behavior. However, few data exist on health risk behaviors among American Indians. We used face-to-face interviews to estimate the prevalence of some of these behaviors among American Indians 15-49 years of age in two Montana locations: on the Blackfeet Reservation and in Great Falls. The prevalence of several important health risk behaviors was higher in these populations than in adult Montana residents in general. Tobacco use was very prevalent. Fifty percent of on-reservation women, 62% of off-reservation women, 34% of on-reservation men, and 63% of off-reservation men were smokers at the time of the survey. Thirty-three percent of reservation men used smokeless tobacco. Other risk behaviors of high prevalence included acute heavy drinking (26% to 42% of men); overweight (29% to 41% of females); sedentary lifestyle (46% to 62% of all respondents); and nonuse of seat belts (64% to 79% of all respondents). Tribal leaders and the Indian Health Service are using the survey results to reduce the prevalence of behaviors harming the health of Indian people. In addition to providing valuable information about the surveyed populations, the survey served as a pilot for subsequent surveys of other American Indian groups.

Adolescent↗