Comparison of Physical Activity, Healthy Eating Habits, and Knowledge of Diabetes and Pre-diabetes in Rural Reservation and Off-reservation Communities.

INTRODUCTION: Residents in two small rural communities on the Northern Great Plains completed surveys to determine their community's needs for physical activity, healthy eating habits, and knowledge of diabetes/pre-diabetes. METHODS: One rural American Indian reservation (Community A) and one off-reservation (Community B) were selected for the study. Both communities had similar population size, medical clinic, pharmacy, grocery store and fitness center. Surveys were collected in-person during local community events. RESULTS: More respondents in Community A (41 percent) compared to Community B (18 percent) used the Fitness Center and had more vigorous physical activity (44 percent vs. 5 percent respectively). Compared to Community A, Community B respondents bought more fruits and vegetables (85 percent vs. 96 percent respectively). While a higher rate of diabetes (15.1 percent) in the American Indian population has been reported, this study did not find a significant difference when comparing these two rural communities. Fewer respondents with diabetes in Community A (25 percent), compared to Community B (85 percent) had attended diabetes education. More respondents in Community A (31 percent) than B (13 percent) had pre-diabetes. CONCLUSIONS: Community A's fitness center had personal trainers that provided education, motivation and encouraged individuals to exercise. The majority of respondents in Communities A (85 percent) and B (96 percent) purchased fruits and vegetables. Fruits and vegetables were readily available in the local grocery stores for both small rural communities. More individuals with diabetes (83 percent) in Community B had attended diabetes education classes. More Community A respondents had pre-diabetes; however, diabetes prevention education could reduce their risk of developing type 2 diabetes by 58 percent.

Blood alcohol levels for American Indian mothers and newborns.

Very little is known about the alcohol elimination rates of newborns who have had chronic alcohol exposure in utero. In these case reports, blood alcohol levels were taken immediately before delivery, at delivery, and postdelivery for 2 mothers who drank alcohol during their pregnancies and 3 single-birth newborns. Newborn A1 of Mother A had no physical characteristics of fetal alcohol syndrome (FAS). The initial blood alcohol level for this newborn was 38.4 mg/dL 129 minutes after birth, with a subsequent blood alcohol level of 5.5 mg/dL 304 minutes after delivery, resulting in an alcohol elimination rate of 11.3 mg/dL per hour. The blood alcohol level for Mother A was 87.4 mg/dL 66 minutes before delivery. Newborn A2 of mother A had FAS. Sixty minutes after delivery, the blood alcohol level for this newborn was 39.5 mg/dL, and the alcohol level of the mother was 42.1 mg/dL. Newborn B1 of mother B had FAS. At 67 minutes after birth, newborn B1 had a blood alcohol level of 246.5 mg/dL, which dropped to 178.7 mg/dL 302 minutes after birth, resulting in an alcohol elimination rate of 17.3 mg/dL per hour. This alcohol elimination rate is within the metabolism range (15-49 mg/dL per hour) of adults with alcoholism. The maternal blood alcohol level was 265.9 mg/dL 27 minutes before delivery. Blood alcohol levels drawn on both the mother and newborn at delivery and 2 or 3 hourly follow-up levels can provide evidence that fetal alcohol dehydrogenase activity is induced by chronic maternal alcohol use.

Hospitalizations of children who have fetal alcohol syndrome or incomplete fetal alcohol syndrome.

INTRODUCTION: The study describes the hospitalization rates and medical diagnoses of children with fetal alcohol syndrome (FAS) and incomplete FAS. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with FAS or incomplete FAS identified from 1981-93 by using the ICD-9-CM code 760.71. Children who had FAS or incomplete FAS were compared to each other and to children who did not have FAS. RESULTS: Compared to the controls, the 43 children with FAS (Study 1) and 35 children with incomplete FAS (Study 2) were hospitalized more often with otitis media (51.2 percent OR=4.32 and 31.4 percent OR=3.02 respectively), pneumonia (46.5 percent OR=4.21 and 34.3 percent OR=2.54), fetal alcohol syndrome (32.6 percent p=.001 and 14.3 percent p=.007), dehydration (23.3 percent OR=9.29 and 17.1 percent OR=4), and anemia (11.6 percent OR=10 and 17.1 percent p=.002) respectively. Children with FAS were hospitalized more often with failure to thrive (32.6 percent p=.001) and neglect (23.3 percent OR=10.0) than children with incomplete FAS and controls. Children with FAS were hospitalized with child sexual abuse (11.6 percent OR=10.0) and feeding problems (11.6 percent p=.007), and children with incomplete FAS were hospitalized with gastroenteritis (22.9 percent OR=14.55) and bronchitis (22.9 percent OR=3.0) more than control children. CONCLUSIONS: Children with FAS or incomplete FAS had more hospitalizations and longer average length of stays than control children.

Characteristics of children whose siblings have fetal alcohol syndrome or incomplete fetal alcohol syndrome.

OBJECTIVE: To describe the clinical features of American Indian children born just before and just after a sibling with fetal alcohol syndrome or incomplete fetal alcohol syndrome. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome or incomplete fetal alcohol syndrome identified from 1981 to 1993 by using International Classification of Diseases, Ninth Revision, Clinical Modification code 760.71. RESULTS: Compared with the controls, the 39 siblings born just before children with fetal alcohol syndrome (study 1) and 30 siblings born just before children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (23.1% and 16.7%, respectively), growth delay (38.5% and 10.0%), and central nervous system impairment (48.7% and 33.3%). The 20 siblings born just after children with fetal alcohol syndrome (study 1) and 22 siblings born just after children with incomplete fetal alcohol syndrome (study 2) had more facial dysmorphology (20.0% and 9.1%, respectively), growth delay (45.0% and 22.7%), and central nervous system impairment (50.0% and 31.8%) than the control siblings. CONCLUSIONS: The "before" siblings had characteristics of fetal alcohol syndrome that could have predicted that the next child was at risk for fetal alcohol syndrome. The "after" siblings had better outcomes than the previous siblings with fetal alcohol syndrome, a finding that was associated with a decrease in maternal alcohol consumption during the after-sibling pregnancy.

Alcohol use, injuries, and prenatal visits during three successive pregnancies among American Indian women on the Northern Plains who have children with fetal alcohol syndrome or incomplete fetal alcohol syndrome.

INTRODUCTION: The purpose of the study was to compare three sequential pregnancies of American Indian women who have children with FAS or children with incomplete FAS with women who did not have children with FAS. METHODS: Two retrospective case-control studies were conducted of Northern Plains American Indian children with fetal alcohol syndrome (FAS) (Study 1) or incomplete FAS (Study 2) in 1981-1993. Three successive pregnancies ending in live births of 43 case mothers who had children with FAS, and 35 case mothers who had children with incomplete FAS were compared to the pregnancies of 86 and 70 control mothers who did not have children with FAS, respectively, in the two studies. Prenatal records were abstracted for the index child (child with FAS or incomplete FAS) and siblings born just before and just after the index child, and comparable prenatal records for the controls. RESULTS: Compared to the controls, significantly more case mothers used alcohol before and after all three pregnancies and during pregnancy with the before sibling and the index child. Mothers who had children with FAS reduced their alcohol use during the pregnancy following the birth of the index child. All Study 1 case mothers (100%) and 60% of Study 2 case mothers used alcohol during the pregnancy with the index child compared to 20 and 9% of respective control mothers. More study 1 case mothers experienced unintentional injuries (OR 9.50) and intentional injuries during the index pregnancy (OR 9.33) than the control mothers. Most case mothers began prenatal care in the second trimester. CONCLUSIONS: Alcohol use was documented before, during and after each of the three pregnancies. Women of child-bearing age should be screened for alcohol use whenever they present for medical services. Mothers who had a child with FAS decreased their alcohol consumption with the next pregnancy, a finding that supports the importance of prenatal screening throughout pregnancy. Women who receive medical care for injuries should be screened for alcohol use and referred for appropriate treatment. Protective custody, case management and treatment services need to be readily available for women who use alcohol.

Characteristics of grandmothers who have grandchildren with fetal alcohol syndrome or incomplete fetal alcohol syndrome.

INTRODUCTION: Characteristics of Northern Plains American Indian maternal grandmothers who had grandchildren with fetal alcohol syndrome (FAS) or incomplete FAS are described to more effectively prevent fetal FAS and alcohol use during pregnancy. METHODS: Study 1 had 27 maternal grandmothers who had grandchildren with FAS and Study 2 had 18 grandmothers with grandchildren who had incomplete FAS (cases) which were compared with 119 maternal grandmothers who had grandchildren without FAS (controls). The grandchildren were born between 1981 and 1993 on the Northern Plains. Medical records were manually reviewed for each case and control grandmother. Data were analyzed using Mantel-Haenszel chi square. RESULTS: Study 1 case grandmothers were more likely to experience medical problems (70.4%) including trauma (48.1%) and injuries (51.9%) than the controls. Most of the Study 1 and 2 case grandmothers (92.6% and 77.8%, respectively) had alcohol use documented in their medical records compared to less than half of the control grandmothers. Seven (15.6%) of the case grandmothers had more than one grandchild in either Study 1 or Study 2. CONCLUSION: Maternal grandmothers who had grandchildren with FAS had significantly higher rates of alcohol use and alcohol-related medical problems than control grandmothers. Antenatal care providers should screen pregnant women for alcohol use at their first visit. The provider needs to ask the women who are using alcohol about their mothers' use of alcohol to provide appropriate care and counseling for the women and prevent FAS.

Characteristics of fathers who have children with fetal alcohol syndrome or incomplete fetal alcohol syndrome.

OBJECTIVES: Determine alcohol use, referrals to treatment, receiving treatment, and medical problems related to alcohol among fathers who have children with FAS or incomplete FAS. METHODS: Fathers who had American Indian children with FAS (Study 1) or incomplete FAS (Study 2) were compared with fathers whose children did not have FAS. RESULTS: About half of case and control fathers had alcohol use and alcohol-related medical problems documented in their medical records. Case fathers were more likely to receive alcohol treatment and have injuries related to alcohol abuse. CONCLUSION: Significantly more fathers of children with FAS were referred for alcohol treatment, received alcohol treatment, experienced injuries, and had delirium tremens than control fathers. Fathers of children with incomplete FAS were significantly more likely to drink alcohol, to have received alcohol treatment, and to have alcohol-related medical problems and injuries than control fathers.

Characteristics of children who have full or incomplete fetal alcohol syndrome.

OBJECTIVE: To describe the clinical features and hospitalization rates of American Indian children with full or incomplete fetal alcohol syndrome (FAS). STUDY DESIGN: Two retrospective case-control studies were conducted of Northern Plains American Indian children with presumed FAS identified from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. Children who had full or incomplete FAS were compared with each other and with children who did not have FAS. RESULTS: Compared with the control children, the 43 children with FAS and the 35 children with incomplete FAS had more facial dysmorphology, growth deficiency, central nervous system dysfunction, and muscular problems and were hospitalized more frequently with otitis media, pneumonia, FAS, dehydration, and anemia. Case children were hospitalized more days than were control children. Case children were removed from their homes and placed in foster care more often than were control children. CONCLUSIONS: Children with full or incomplete FAS had many health, learning, and social needs. Health care providers and community programs should identify the needs of these children and offer optimal services to meet those needs.

Characteristics of mothers who have children with fetal alcohol syndrome or some characteristics of fetal alcohol syndrome.

BACKGROUND: Health care providers can more effectively prevent fetal alcohol syndrome and prenatal alcohol exposure if they know more about mothers who have children with fetal alcohol syndrome (FAS) or some characteristics of FAS. METHODS: We conducted two retrospective case-control studies of Northern Plains Indian children with FAS and some characteristics of FAS diagnosed from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. We compared mothers who had children with FAS or some characteristics of FAS with mothers who had children that did not have FAS. RESULTS: Compared with control mothers, 43 mothers who had children with FAS and 35 mothers who had children with some characteristics of FAS were older, had fewer prenatal visits, more pregnancies, more mental health problems, and more injuries (both total and alcohol-related). Although the prevalence of drinking was high in both case and control mothers, case mothers had more alcohol-related medical problems, drank heavily, in binges, and daily more often than control mothers. CONCLUSIONS: Women with injuries and mental health problems should be screened for substance use. Mothers of children with FAS or of some characteristics of FAS have numerous needs that must be addressed to prevent future prenatal alcohol exposure.