Reduction of variability in the anovulatory period following medroxyprogesterone acetate injection by using jet injectors.
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T K Welty
Publications and source records attributed to T K Welty.
Intake of nutrients related to cardiovascular disease risk among three groups of American Indians: the Strong Heart Dietary Study.
BACKGROUND: Although diet is implicated in the elevated rate of cardiovascular disease among some American Indian tribes, the dietary intakes of these individuals have not been described. The Strong Heart Dietary Study compared diets of 10 tribes in Arizona, Oklahoma, and the Dakotas to examine the possible contribution of diet to cardiovascular and other chronic diseases. METHODS: During 1988-1991, 892 people responded to a 24 hr diet recall questionnaire. Nutrient intake by study area, sex, and age group were compared by analysis of variance, and intakes were compared with nutrient intakes reported by participants in Phase 1 of the Third National Health and Nutrition Examination Survey and with dietary recommendations of the National Research Council, the American Heart Association, and the Healthy People 2000 objectives. RESULTS: The intake of energy and nutrients varied significantly by sex and age. Men consumed more energy, macronutrients, and sodium than did women (P < or = 0.001). Women's diets were denser in carbohydrate, beta-carotene, vitamin C, and vitamin E than were men's diets (P < or = 0.001). Younger participants consumed more energy, macronutrients, vitamin E, and sodium than did older participants (P < or = 0.001). Older participants had diets denser in protein and beta-carotene than did younger participants (P < or = 0.001). Energy intake did not differ significantly by study area, but men in Arizona consumed more energy from carbohydrate and less energy from total fat than did men elsewhere (P < or = 0.01). Men and women in Arizona consumed more cholesterol and fiber than did other participants (P < or = 0.01) and less of the antioxidant vitamins (P < or = 0.01). Participants in the Strong Heart Diet Study reported diets higher in fats and cholesterol than did participants in Phase 1 of the Third National Health and Nutrition Examination Survey. Few Strong Heart participants achieved dietary recommendations for the reduction of risk of chronic disease. CONCLUSIONS: Area differences in nutrient intake were observed, but most participants consumed diets associated with increased risk of heart disease and other chronic diseases. Women and older participants in general reported healthier nutrient intakes. Dietary intervention programs should educate American Indians about dietary modifications to reduce the risk of cardiovascular and other nutrition-related disorders.
Age Distribution↗
Relationship of prenatal alcohol use with maternal and prenatal factors in American Indian women.
Demographic factors and patterns of substance use among women who did not consume alcohol during pregnancy were compared to women who did consume alcohol during pregnancy. One-hundred seventy-seven Northern Plains Indian women who received prenatal care at an urban clinic in a rural state were screened for substance use as part of the validation study with a self-administered questionnaire. Women who drank during pregnancy were more likely to be single and have less education than women who did not drink. While most of the women in the study had available transportation resources, the women who drank during pregnancy were less likely to have transportation than the women who did not drink. Women who drank during pregnancy consumed more alcohol more frequently before pregnancy than did women who drank before but not during pregnancy. Compared to women who did not drink during pregnancy, women who drank during pregnancy were more likely to smoke cigarettes and use illicit drugs, to have parents who drank, to feel they drank the same or more than other pregnant women, or to have experienced more relationship breakups and physical and emotional abuse. Prenatal patients who drink alcohol during pregnancy need more intensive counseling regarding their multiple risk behaviors.
Adult↗
Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study.
BACKGROUND: Both a prolonged QT interval and increased QT interval dispersion (QTD) have been proposed as surface ECG markers of vulnerability to ventricular arrhythmias and potential predictors of mortality. METHODS AND RESULTS: The predictive values of QT prolongation and QTD were assessed in 1839 participants in the Strong Heart Study, a prospective study of cardiovascular disease in American Indians. ECGs were acquired at 250 Hz; QT intervals were measured by computer in all 12 leads and corrected for heart rate (QTc) by use of Bazett's formula. QTD was calculated as the difference between the maximum and minimum QTc. After a mean follow-up of 3.7+/-0.9 years, there were 188 deaths from all causes, including 55 cardiovascular deaths. In univariate Cox analyses, prolonged QTc and increased QTD were significant predictors of all-cause mortality (chi(2)=53.0, P<0.0001; chi(2)=11.3, P=0.0008) and cardiovascular mortality (chi(2)=14.7, P=0.0001; chi(2)=26.5, P<0.0001). In multivariate Cox regression analyses controlling for risk factors, QTc remained a strong predictor of all-cause mortality (chi(2)=16.5, P<0.0001) and a weaker predictor of cardiovascular mortality (chi(2)=5.8, P=0.016); QTD remained a significant predictor of cardiovascular mortality only (chi(2)=12.5, P=0.0004). CONCLUSIONS: These findings support the value of computerized measurements of QTc and QTD in noninvasive risk stratification and suggest that these surface ECG variables may reflect different underlying abnormalities of ventricular repolarization.
Aged↗
Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes.
BACKGROUND: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. METHODS: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. RESULTS: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. CONCLUSION: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.
Aged↗
The expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans.
To quantify the expected impact of a smoking cessation program for pregnant women on infant mortality among Native Americans, we estimated the proportional reduction (impact fraction) and the absolute reduction (impact risk) in neonatal and postneonatal mortality as a result of the intervention program. The estimated attributable fraction due to maternal smoking was 16.6% of infant deaths in the Aberdeen Indian Health Service (IHS) Area, 16.2% in the Alaska IHS Area, and 5.2% in the Navajo IHS Area. Under the assumptions that 14% of the smokers participating in a smoking cessation program would quit and that the intervention would have 60% relative efficacy in preventing infant deaths attributable to smoking, the impact fraction was estimated to be 0.9% of all infant deaths in the Aberdeen Area, 1.0% in the Alaska Area, and 0.3% in the Navajo Area. Under the "best" model assumptions (28% cessation rate and 90% relative efficacy), 2.6% of all infant deaths, 3.7% of postneonatal deaths, and 1.2% of neonatal deaths would be prevented by a smoking cessation program in the Aberdeen Area. When applied to 1984-1986 infant mortality data, the impact risk per 100,000 live births under the "best" model assumptions was 10 neonatal deaths and 41 postneonatal deaths in the Aberdeen Area, 10 neonatal and 34 postneonatal deaths in Alaska, and 2 neonatal and 8 postneonatal deaths in the Navajo Area. This report points to the need to develop effective smoking cessation programs for Native Americans, targeted in particular to women of reproductive age.
Adult↗
The Indian burden of illness and future health interventions.
This article describes the burden of illness of Indians eligible for services from the Indian Health Service (IHS) and discusses strategies for reducing morbidity and mortality related to those conditions. To improve health to an extent that parallels the IHS's past achievements, the illnesses that now are prevelant among Indians require changes in personal and community behavior rather than intensified medical services. Analysis of these conditions leads to the conclusion that much of the existing burden of illness can be reduced or eliminated. IHS is responding to this challenge by continuing to ensure Indians' access to comprehensive health care services, by increasing educational efforts aimed at prevention, and by enlisting the support of other government and private organizations in activities that have as their purpose treating diseases if intervention will lessen morbidity and mortality (such as diabetes and hypertension) and encouraging of dietary changes, cessation of smoking, exercise, reduction in alcohol consumption, and other healthy behavior.
Adolescent↗
Epidemiology of Haemophilus influenzae type B disease among Navajo Indians.
During a 7-year period ending June 30, 1980, the annual incidence of all Haemophilus influenzae type b disease among Navajo children less than 5 years old was 214 per 100,000, and that of H. influenzae meningitis was 152 per 100,000. Eighty-one percent of H. influenzae meningitis occurred in children 12 months of age or younger, and 64 percent clustered in children ages 4 through 8 months. Meningitis accounted for 70 percent of all invasive disease. No epiglottitis was observed. The epidemiology is similar to that in Yupik Eskimos, who have an even higher rate of H. influenzae type b disease than Navajos but are a much smaller population. Mortality from H. influenzae meningitis was low (4 percent) among Navajo children, but neurological sequelae were observed in at least 16 percent of the survivors. This high rate of sequelae may be due in part to clustering of cases in infancy. Among normal Navajo neonates, 79 percent had maternal capsular type b antibody titers greater than or equal to 0.15 micrograms per deciliter (microgram per dl), and the whole group had a geometric mean titer of 0.51 micrograms per dl. By age 4 months, when meningitis cases became frequent, only 14 percent of Navajo infants had antibody titers greater than or equal to 0.15 micrograms per dl. Twelve of 67 asymptomatic infants (18 percent), each monitored every 2 months, had H. influenzae type b or a cross-reacting organism isolated from the pharynx on at least one occasion before they were 9 months old. Active immunization would be theoretically indicated in this population with high H.influenzae type b exposure and disease, but a vaccine would have to confer substantial immunity in very young infants.
Adolescent↗
Cost-benefit of a streptococcal surveillance program among Navajo Indians.
A school-based streptococcal surveillance program has been in effect among Navajo Indians for more than 4 years. Throat cultures of symptomatic children are obtained when indicated, and routine throat cultures are performed monthly. Children whose cultures are positive for group A beta-hemolytic streptococci are treated. During 4 academic years, between 48 percent and 56 percent of elementary school children attended the schools that had 4 or more monthly surveys in each year, but only 24 percent (7 of 29) of the acute rheumatic fever (ARF) cases occurred in children at those schools. Six of seven children attending covered schools were not cultured before their ARF episodes. Five cases occurred in children attending previously covered schools, during years in which participation lapse. Three or four ARF cases per year appeared to have been prevented, but the program's costs were five times the estimated costs of the prevented cases, even excluding risks of allergic reactions to penicillin. There is little evidence that most asymptomatic carriers are at risk to develop ARF. The authors recommend that streptococcal surveillance efforts be confined largely to culturing throat swabs of children with pharyngitis.
Adolescent↗
Cancer risk factors in three Sioux tribes. Use of the Indian-specific health risk appraisal for data collection and analysis.
Cancer mortality rates for Aberdeen Area Indians exceed U.S. rates with lung cancer being the leading cause of cancer death. The Sioux Cancer Study, an ancillary study of the Strong Heart Study, investigated cancer and cancer risk factors among tribal members aged 45-74 in three Sioux tribes in North and South Dakota. An Indian-specific health risk appraisal was used to collect data and provide specific recommendations to participants. The high rates of smoking (56% for men and 48% for women) explain the high lung cancer mortality rates. Intensive smoking cessation and prevention programs will likely have the greatest impact in reducing preventable cancer deaths. More accessible cervical and breast cancer screening provided by female health care providers is needed to reduce preventable cancer deaths among Sioux women. Pap smear screening is an especially high priority since cervical cancer mortality is 4.4 times higher than U.S. rates, all races. Programs targeted to reduce obesity and excessive alcohol use will also likely reduce preventable cancer deaths associated with high rates of obesity, diabetes and binge drinking. Community-based cancer prevention and control programs tailored to the cancer risk factor profile of the community are the best strategy to reduce preventable cancer deaths in Indian communities.
Aged↗
Bacterial meningitis in Navojo Indians.
An analysis of 219 confirmed cases of bacterial meningitis among Navajo Indians during a 5-year period, July 1, 1968, through June 30, 1973, revealed that 56 percent were caused by Haemophilus influenzae, 26 percent by Neisseria meningitidis, 6 percent by Mycobacterium tuberculosis, and 6 percent by other organisms. The annual incidence of H. influenzae meningitis (17.7 per 100,000 persons) and that of pneumococcal meningitis (8.0 per 100,000) were much higher than the rates for these diseases reported from other population groups. The annual incidence of meningococcal meningitis (2.0 per 100,000) was similar to that found elsewhere. There was an ususual concentration of cases during the first year of life; 78 percent of H. influenzae, 64 percent of pneumococcal, and 50 percent of meningococcal meningitis occurred during this time. However, bacterial meningitis during the first month of life was not frequent (0.29 per 1,000 live births). Case fatality rates were similar to those reported for other population groups.
Adolescent↗
Along for the ride: the prevalence of motor vehicle passengers riding with drivers who have been drinking in an American Indian population.
American Indians, especially those residing in the Northern Plains, experience considerable preventable morbidity and mortality from alcohol-related motor vehicle events. Research focusing on unintentional injuries associated with drinking drivers has disregarded the epidemiology of their passengers, who are equally at risk. The purpose of this investigation was to define the prevalence of motor vehicle passengers riding with drivers who have been drinking on a Northern Plains Reservation. We surveyed a sample of 151 Northern Plains Indians about their experiences riding with drinking drivers. Associated behavioral and demographic risk factors were also examined to identify possible predictor variables. The majority (54%) of respondents reported riding with a driver who had been drinking at least once during the previous three months. Most often, passengers ride with a friend who has been drinking, on a weekend night. Injury risk may be compounded because few respondents reported regular seat-belt use. The results off our study suggest the need for immediate comprehensive prevention efforts focusing on motor vehicle passengers.
Adolescent↗