Building the ship of death.
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Attitude to Death↗
Biomedical subjects
J Coulehan
Publications and source records attributed to J Coulehan.
Metabolic control in non-insulin-dependent diabetes mellitus: factors associated with patient outcomes.
We conducted a cross-sectional study to assess the association of various demographic and medical-care variables with metabolic outcomes in non-insulin-dependent diabetic subjects. The study population was representative of the diagnosed care-seeking diabetic population of a defined geographic community on the Navajo reservation in Arizona. The dependent variable metabolic control was measured as the mean of all random plasma glucose values obtained only at scheduled diabetes clinic visits over 2 yr. Multivariate analysis of the data showed that better metabolic control was most strongly associated with compliance with scheduled appointments. Mode of treatment was also associated with metabolic control. Other variables tested, including source of care, age, sex, duration of diabetes, presence of complications, and weight change, were not associated with metabolic control. The strongest analysis of covariance model with demographic and medical-care variables accounted for 39% of the variance in metabolic control. The analysis suggests that other variables, possibly including several psychosocial variables, need to be assessed for their contribution to metabolic control.
Arizona↗
Comparison of metabolic control among diabetic subjects at two clinics.
A cross-sectional study was conducted to investigate whether glucose control in 20 non-insulin-dependent diabetic subjects seen at a remote rural clinic was comparable to control achieved in 66 diabetic subjects seen at the regional hospital clinic. Sampling was done to assure that study subjects were representative of all care-seeking, diagnosed diabetics in a well-defined Navajo community. The two groups of patients were comparable in terms of age, sex, and duration of diabetes from time of diagnosis. Compliance with care, hospitalization rates, and complication rates were similar in each group. Results showed no significant differences in glycemic control between the rural clinic (mean fasting plasma glucose = 177, mean random plasma glucose = 227) and the regional hospital clinic (mean fasting plasma glucose = 187, mean random plasma glucose = 249). The percentages of diabetics under "acceptable" control by American Diabetes Association guidelines was 40 percent at the rural clinic and 29 percent at the hospital clinic (P greater than .05). The authors conclude that adequacy of glycemic control in diabetics is not compromised by providing care at a remote rural clinic.
Ambulatory Care Facilities↗
Acute rheumatic fever and rheumatic heart disease on the Navajo reservation, 1962-77.
The occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) among Navajos was ascertained for the period from 1962 through 1977 by means of hospital discharge diagnoses and patients' charts. The annualized attack rate for ARF was 12.4 per 100,000 population, with no clear evidence of an overall secular trend. The proportion of recurrences (19.6 percent) and clinical features were similar to those reported elsewhere, but no seasonal variation in attack rates was noted. Between 1962-71 and 1972-77, the age of RHD patients increased, suggesting few newly diagnosed cases and the aging of known patients. A streptococcal disease control program was instituted in many Navajo elementary schools before 1975. In the program, throat cultures were performed routinely for some asymptomatic children and for all symptomatic children. During the subsequent 3 years, ARF rates declined from 13.5 to 8.2 per 100,000 in areas covered by the program, while in the noncovered areas the rates showed little change-9.5 to 10.1 per 100,000.
Acute Disease↗