Preventing amputations from Diabetes Mellitus: The Indian health service experience

With the heavy burden of diabetes mellitus among American Indians and Alaskan Natives, lower-extremity amputation (LEA) has become a common complication. Rates of diabetes-related LEA are 2-3 times those observed in other diabetic populations. During the past 12 years, the Indian Health Service (IHS) has made LEA prevention a public health priority. From 1988 to 1992 screening criteria based on simple examinations were developed and validated in primary care settings. Prevention efforts have focused on targeting high-risk individuals for self-care foot education, provision of protective footwear, and routine podiatry care. Follow-up studies in Alaska and northern Minnesota saw 25-50 percent reduction in LEA rates associated with these interventions. In settings where these efforts were augmented with system changes, such as team coordination, patient tracking systems, comprehensive footcare practice guidelines, flowsheets, and outreach programmes, LEA incidence was reduced by 50-75 percent. Efforts were currently underway to desseminate system-based approaches for comprehensive diabetic footcare and to expand the availability of foot care resources to tribal communities served by the IHS.(Au)

A review of cardiovascular diseases in developing countries

This review examines the possible association in undeveloped and developing communities between 'development' and blood pressure, coronary heart disease and rheumatic heart disease. Previous studies have shown that hypertension is rare and coronary heart disease almost unknown in many of the more isolated and less developed communities, whilst rheumatic heart disease is relatively common. Consideration is given to the possibility that development in such communities may lead to a higher incidence of hypertension and coronary heart disease and to a reduction in the amount of rheumatic heart disease. Epidemiological methods for separating environmental and genetic causes are discussed. Some more recent studies in genetically different 'primitive' groups are reviewed, and then methods are discussed for the control of the genetic component, based on the examination of one genetic group living at different levels of development, either at the same time or at different times. The advantages of using migrant studies are outlined and some examples are given. The evidence appears to favour the hypothesis that development is associated with a greater incidence of hypertension and coronary heart disease, but there is little to suggest that the incidence of rheumatic heart disease is decreasing with development (AU)

Teenage pregnancy in Trinidad

The reproductive performance of 368 Negro and 87 East Indian mothers under 16 years of age was studied. Their marital status, desire for the pregnancy, and outcome of the pregnancy were recorded. There was a high incidence of unwanted pregnancies in both groups of patients. Hypertension, prolonged labour and postpartum haemorrhage occurred more commonly among Indians but the operative delivery rate was higher in Negroes (AU)

Geographical studies on rheumatoid arthritis

The prevalence of rheumatoid arthritis has been compared in eight population samples in America and Europe, in which routine x rays were taken of the hands and feet. All the x rays were read by one observer. No relationship to lattitude was discovered. The prevalence of "definite" arthritis was not significantly different in the three racial groups included in these surveys, but "probable" disease was more common in the Negro population in Jamaica than in the Amerindians or Caucasians. Radiological evidence of erosive arthritis was more frequent in the Jamaican than in the Amerindian, and the Amerindian than the Caucasian. Serological tests for rheumatoid factor were more often positive in the Amerindian and erosive changes more severe. The implications of these findings are discussed.(Summary)