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PubMedDate not supplied

Guidelines for the management of head injuries in remote and rural Alaska.

Numerous recommendations on the initial evaluation and treatment of the head injured patient have been proposed over the last several years. Most assume there is readily available access to computed tomography and neurosurgical specialists. Many clinicians in Alaska must evaluate and begin treatment of head injured patients in circumstances quite different from this. Vast distances, severe weather and limited medical evacuation capability are factors that come into play while caring for these patients. The current medicolegal climate also contributes to clinician anxiety over missing rare but potentially serious injuries. These guidelines developed by Alaska clinicians from multiple specialties are meant to assist clinicians dealing with this very common problem and represent a reasonable approach to these patients in remote and rural Alaska.

Alaska↗
PubMed1999

Suicide attempts among American Indian and Alaska Native youth: risk and protective factors.

CONTEXT: American Indians and Alaska Natives have the highest suicide rates of all ethnic groups in the United States, and suicide is the second leading cause of death for American Indian and Alaska Native youth. OBJECTIVE: To identify risk and protective factors associated with suicide attempts among native male and female adolescents. DESIGN: The 1990 National American Indian Adolescent Health Survey. SETTING: Schools of reservation communities in 8 Indian Health Service areas. PARTICIPANTS: Eleven thousand six hundred sixty-six 7th- through 12th-grade American Indian and Alaska native youth. MAIN OUTCOME MEASURES: Responses were compared among adolescents with and without a self-reported history of attempted suicide. Independent variables included measures of community, family, and individual characteristics. Separate analyses were conducted for boys and girls. RESULTS: Ever attempting suicide was reported by 21.8% of girls and 11.8% of boys. By logistic regression done on boys and girls separately, suicide attempts were associated with friends or family members attempting or completing suicide; somatic symptoms; physical or sexual abuse; health concerns; using alcohol, marijuana, or other drugs; a history of being in a special education class; treatment for emotional problems; gang involvement; and gun availability. For male and female youth, discussing problems with friends or family, emotional health, and connectedness to family were protective against suicide attempts. The estimated probability of attempting suicide increased dramatically as the number of risk factors to which an adolescent was exposed increased; however, increasing protective factors was more effective at reducing the probability of a suicide attempt than was decreasing risk factors. CONCLUSIONS: A history of attempted suicide was associated with several risk and protective factors. In addition to targeting youth at increased risk, preventive efforts should include promotion of protective factors in the lives of all youth in this population.

Adolescent↗
PubMed1996

A program to control an outbreak of hepatitis A in Alaska by using an inactivated hepatitis A vaccine.

OBJECTIVE: To stop an epidemic of hepatitis A in rural Alaska by mass immunization of susceptible persons with 1 dose of an inactivated hepatitis A vaccine. DESIGN: Nonrandomized, uncontrolled trial. Hepatitis A vaccine was offered to all persons in susceptible age groups in villages with documented cases of hepatitis A. Immune globulin was not offered at the time of vaccination. SETTING: Twenty-five rural communities located in interior Alaska and along the northwest coast of the Bering Sea and Arctic Ocean. PARTICIPANTS: Persons without a history of acute hepatitis A in age groups selected by applying results of a previous serosurvey conducted on serum collected before the epidemic. INTERVENTION: One dose of a formalin-inactivated hepatitis A vaccine was given to each participant. Adults 20 years of age and older received 1440 enzyme-linked immunosorbent assay units and persons younger than 20 years received 720 enzyme-linked immunosorbent assay units. Prevaccination and postvaccination levels of antibody to hepatitis A IgG were obtained from 136 participants. MAIN OUTCOME MEASURES: An active surveillance system was established to detect persons with symptomatic illnesses compatible with hepatitis A; persons who met the illness criteria were tested for antibody to hepatitis A IgM. One area (the Kotzebue region), where all communities were offered vaccine, was selected for intensive surveillance and analysis. RESULTS: During the 12-month period before the vaccine trial, 529 cases of icteric hepatitis A were reported, and 443 were confirmed to be positive for antibody to hepatitis A IgM. Hepatitis A vaccine was administered to 4930 persons, 3517 of whom were younger than 20 years. After vaccination began, 237 persons positive for antibody to hepatitis A IgM were identified during a 60-week surveillance period; 46 were vaccines and 191 were unvaccinated susceptible persons. In the Kotzebue region, in communities in which more than 80% of persons considered susceptible were vaccinated, the outbreak ceased in 4 to 8 weeks, whereas in 1 large community in which less than 50% of susceptible persons were vaccinated, the outbreak continued for more than 50 weeks. More than 90% of seronegative persons developed antibody to hepatitis A IgG 3 to 4 weeks after vaccination. CONCLUSION: This trial suggested that by providing both short-term and long-term protection, hepatitis A vaccine used without immune globulin halted an established epidemic of hepatitis A in rural Alaska.

Adolescent↗
PubMed1992

American Indian--Alaska Native youth health.

OBJECTIVE: To assess risk behaviors, health problems, worries and concerns, and resiliency-promoting factors among American Indian-Alaska Native adolescents. DESIGN: Survey. SETTING: Nonurban schools from eight Indian Health Service areas. PARTICIPANTS: A total of 13,454 seventh- through 12th-grade American Indian-Alaska Native youths. MAIN OUTCOME MEASURES: revised version of the Adolescent Health Survey, a comprehensive, anonymous, self-report questionnaire with 162 items addressing 10 dimensions of health. RESULTS: Poor physical health was reported by 2% of the study sample and was significantly correlated with social risk factors of physical and/or sexual abuse, suicide attempts, substance abuse, poor school performance, and nutritional inadequacies. Injury risk behaviors included never wearing seatbelts (44%), drinking and driving (37.9% of driving 10th through 12th graders), and riding with a driver who had been drinking (21.8%). Physical and sexual abuse prevalence was 10% and 13%, respectively, with 23.9% of females reporting physical abuse and 21.6% of females reporting sexual abuse by the 12th grade. Almost 6% of the entire sample endorsed signs of severe emotional distress. Eleven percent of the teens surveyed knew someone who had killed himself or herself, and 17% had attempted suicide themselves. Sixty-five percent of males and 56.8% of females reported having had intercourse by the 12th grade. Weekly or more frequent alcohol use rose from 8.2% of seventh graders to 14.1% by the 12th grade; for males, the survey noted an increase in regular alcohol use of 3% to 5% a year to 27.3% by the 12th grade. For each variable measured, rates are much higher for American Indian adolescents than those for rural white Minnesota youth, except for age at first intercourse and alcohol use. CONCLUSIONS: American Indian-Alaska Native adolescents reported high rates of health-compromising behaviors and risk factors related to unintentional injury, substance use, poor self-assessed health status, emotional distress, and suicide. Interventions must be culturally sensitive, acknowledge the heterogeneity of Indian populations, be grounded in cultural traditions that promote health, and be developed with full participation of the involved communities.

Adolescent↗
PubMed1998

Surveillance for nonfatal work-related injuries in Alaska, 1991-1995.

Historically, Alaska has had an occupational fatality rate five times greater than that for the United States. This article reports recent surveillance results for hospitalized nonfatal work-related injuries in Alaska, using the population-based Alaska Trauma Registry (ATR) from 1991 through 1995. The fishing, construction, and logging industries led with the highest number of reported cases in the ATR. Workers in the logging, water transportation, and wood product manufacturing industries had the highest injury rates. Cause, severity, type, and body region of injury were examined for each target industry. For industries with the highest numbers and rates of injuries, in most cases, falls were identified as a common cause of injuries. A fractured bone was the most common type of injury, and the extremities were the most common body region affected. The ATR has proved to be a reliable tool for work-related injury surveillance and will be helpful in planning research priorities and targeting injury prevention efforts.

Accidental Falls↗
PubMed1990

High incidence of sudden infant death syndrome among northern Indians and Alaska natives compared with southwestern Indians: possible role of smoking.

Epidemiologic studies of sudden infant death syndrome (SIDS) in the United States have found a particularly high incidence among American Indians and Alaska Natives compared with whites. This report shows that there is a remarkable difference in the incidence of SIDS between Northern Indians and Southwestern Indians. From 1984 through 1986, the incidence of SIDS was 4.6 per 1,000 live births among Indians and Alaska Natives in the Northern region of the United States, while the incidence among Southwestern Indians was 1.4 per 1,000 live births (risk ratio = 3.4; 95 percent confidence interval = 2.4-4.8). Among whites living in the same regions, the incidence of SIDS was 2.1 and 1.6 per 1,000 live births, respectively. The incidence among Native Americans in the Northern region was high in all five Indian Health Service Areas. Differences in socioeconomic status, maternal age, birth weight, and prenatal care did not appear to explain the higher incidence of SIDS among Northern Indians compared with Southwestern Indians. However, the prevalence of maternal cigarette smoking during pregnancy is exceptionally high among Northern Indians and Alaska Natives, while it is low among Southwestern Indians. This difference in smoking habits may explain, at least in part, the excess risk of SIDS among Indians in the Northern region. This report points to the need for effective smoking cessation programs for Native Americans, targeting in particular women of reproductive age.

Alaska↗
PubMed2006

Invasive early-onset neonatal group B streptococcal cases--Alaska, 2000-2004.

OBJECTIVE: We conducted a review of invasive early-onset neonatal group B Streptococcus (GBS) infections that occurred during 2000-2004 in Alaska to determine the proportion of cases that might have been prevented by complete implementation of the 2002 Centers for Disease Control and Prevention (CDC) guidelines. METHODS: Cases were identified from statewide laboratory-based surveillance conducted by the CDC Arctic Investigations Program, and from the Alaska Medicaid database using International Classification of Diseases 9 codes 038.0, 041.02, 320.2, and 482.3. Neonates were considered to have early-onset disease if clinical illness within 6 days after birth was accompanied by GBS isolation from a normally sterile site. Maternal and neonatal medical records were reviewed. Potentially preventable cases were those for whom the 2002 CDC GBS maternal screening and intrapartum antimicrobial prophylaxis (IAP) guidelines were not completely implemented. Preventability of events not related to clinician implementation of the guidelines were not considered. RESULTS: Twenty-one neonates with invasive early-onset GBS disease were identified (0.42/1,000 live births). Three of the eight mothers for whom IAP was indicated, did not receive adequate IAP. Nine of the 13 mothers for whom there was no indication for IAP, had not been screened appropriately. Therefore, a total of 12 neonates were determined to have had potentially preventable GBS disease. CONCLUSIONS: Over 50% of the invasive early-onset neonatal GBS cases in Alaska were potentially preventable. The majority of these cases may have been prevented by closer adherence to either specific IAP administration guidelines or to maternal screening guidelines.

Alaska↗
PubMed2006

An exploratory study of total mercury levels in archaeological caribou hair from northwest Alaska.

Over the past ten years, total mercury (THg) levels have been surveyed in Alaskan wildlife and fish as part of the Arctic Monitoring and Assessment (AMAP). Beyond these studies there is little historical data on THg levels in important subsistence species for people in Alaska. A survey of THg in caribou hair from archaeological deposits would provide data to develop temporal trends for this region of the Arctic. Caribou hair from a Western Thule settlement beneath the Alaska native village of Deering (ca. AD 1150) show variability in hair THg values, with a mean level (86 ng/g) which is in the range that is observed in modern Rangifer sp. (caribou and reindeer). Hair from House 1 had a THg mean level of 99.6 ng/g and hair from House 2 had a THg mean of 64.2 ng/g. This is the earliest reported record of mercury in caribou associated with human subsistence activities in the western North American Arctic, and is a first step toward compilation of a needed database through which to measure and evaluate exposure to mercury by people who rely heavily on caribou as a food source. We hypothesize that similarity in mercury values in archaeological samples of caribou and in contemporary samples would give an additional perspective on human exposure to mercury through caribou harvest and consumption today. Since this hypothesis will be more useful if evaluated at a regional rather than global scale, further studies will be needed at different archaeological sites across Alaska to determine the generality of this observation in relation to geographic scale.

Alaska↗
PubMed2004

The incidence of infant physical abuse in Alaska.

OBJECTIVES: To determine the incidence of and risk factors associated with infant (< 1 year of age) physical abuse in Alaska. METHODS: A population-based retrospective cohort study for the 1994-2000 resident birth cohort was conducted by linking data from birth certificates, Child Protective Services, a statewide hospital-based trauma registry, hospital discharge data, and the Alaska Infant Mortality Review (including death certificates). The main outcome measures were the incidences of overall physical abuse and abuse resulting in hospitalization or death. A case of child abuse was defined as an instance of substantiated physical abuse to an infant identified in the Child Protective Services database or an infant death with homicide identified on the death certificate as the manner of death. RESULTS: During the 7-year study period, there were 70,842 births and 325 cases of physical abuse including 72 that led to hospitalization (n = 58), death (n = 4), or both (n = 10); respective incidences for all abuse and abuse leading to hospitalization or death were 4.6 and 1.0 per 1000 live births. Following multivariate analyses, the risk factors with the highest population attributable risks were maternal or paternal education < or = 12 years, unmarried mother, and maternal prenatal substance use. To determine if the study methodology was likely to have missed cases of severe abuse, we examined information for all 216 infants hospitalized for trauma during the study period who did not have identification of abuse in one of the study databases; of these, at least 39 had injuries inconsistent with the reported mechanism (a long bone or skull fracture that reportedly resulted from a fall of less than 3 feet or from a caretaker's arms or for which the caretaker denied a history of trauma). CONCLUSIONS: Alaska has one of the highest documented infant physical abuse incidences reported in the literature and abuse is associated with potentially modifiable-primarily social-risk factors. Despite this high incidence, substantial under-reporting of hospitalized cases likely occurs.

Alaska↗
PubMed2006

Scientific research, stakeholders, and policy: continuing dialogue during research on radionuclides on Amchitka Island, Alaska.

It is increasingly clear that a wide range of stakeholders should be included in the problem formulation phase of research aimed at solving environmental problems; indeed the inclusion of stakeholders at this stage has been formalized as an integral part of ecological risk assessment. In this paper, we advocate the additional inclusion of stakeholders in the refinement of research methods and protocols and in the execution of the research, rather than just at the final communication and reporting phase. We use a large study of potential radionuclide levels in marine biota around Amchitka Island as a case study. Amchitka Island, in the Aleutian Island Chain of Alaska, was the site of three underground nuclear tests (1965-1971). The overall objective of the biological component of the study was to collect a range of marine biota for radionuclide analysis that could provide data for assessing current food safety and provide a baseline for developing a plan to monitor human and ecosystem health in perpetuity. Stakeholders, including regulators (State of Alaska), resource trustees (US Fish and Wildlife Service, State of Alaska), representatives of the Aleut and Pribilof Island communities, the Department of Energy (DOE), and others, were essential for plan development. While these stakeholders were included in the initial problem formulation and approved science plan, we also included them in the refinement of protocols, selection of bioindicators, selection of a reference site, choice of methods of collection, and in the execution of the study itself. Meetings with stakeholders resulted in adding (or deleting) bioindicator species and tissues, prioritizing target species, refining sampling methods, and recruiting collection personnel. Some species were added because they were important subsistence foods for the Aleuts, and others were added because they were ecological equivalents to replace species deleted because of low population numbers. Two major refinements that changed the research thrust were (1) the inclusion of Aleut hunters and fishers on the biological expedition itself to ensure that subsistence foods and methods were represented, and (2) the addition of a fisheries biologist on a NOAA research trawler to allow sampling of commercial fishes. Although the original research design called for the collection of biota by Aleut subsistence fishermen, and by a commercial fishing boat, the research was modified with continued stakeholder input to actually include Aleuts and a fisheries biologist on the expeditions to ensure their representation. The inclusion of stakeholders during the development of protocols and the research itself improved the overall quality of the investigation, while making it more relevant to the interested and affected parties. Final responsibility for the design and execution of the research and radionuclide analysis rested with the researchers, but the process of stakeholder inclusion made the research more valuable as a source of credible information and for public policy decisions.

Alaska↗
PubMed2006

Analysis of recent vessel arrivals and ballast water discharge in Alaska: toward assessing ship-mediated invasion risk.

Ships are a dominant vector for biological invasions through ballast water discharge (BWD) and hull fouling. Here, we provide a first comprehensive analysis of shipping in Alaska, summarizing (a) the number, type and origin of vessel arrivals to Alaska for 2003 and 2004, (b) the spatial and temporal variation in vessel traffic, and (c) the available data on ballast water discharge in order to prioritize locations for tracking biological invasions. Most arrivals were passenger vessels, followed by ferries and fishing vessels, all of which carried little ballast water. Regional and seasonal patterns in arrivals and BWD were unevenly distributed among vessel types. The majority of vessels reporting BWD were from foreign ports, and most of this ballast was untreated. The largest volumes of ballast were from tankers at Valdez and Kenai Peninsula ports. Although Alaska has few documented invasions, opportunities for ship-mediated transfer now appear high and warrant further scrutiny.

Alaska↗
PubMed2005

A comparison of the non-essential elements cadmium, mercury, and lead found in fish and sediment from Alaska and California.

Concentrations of three non-essential elements (cadmium (Cd), mercury (Hg), and lead (Pb)) were determined in sediment and fish from several locations in Alaska (AK) and California (CA) and used to examine differences in bioaccumulation within and between geographic locations. We analyzed tissue (liver, muscle, gill, and stomach contents) from white croaker (Genyonemus lineatus) and English sole (Pleuronectes vetulus) in California and flathead sole (Hippoglossoides elassodon) in Alaska, in addition to several species of invertebrates (mercury only). As found in previous work on arsenic (As) [Meador et al., 2004], Cd in fish liver exhibited a negative correlation with sediment concentrations. No such correlations were found for Hg and Pb when fish liver and sediment were compared; however, these metals did exhibit a positive relationship between liver and organic carbon normalized sediment concentrations, but only for the CA sites. Sediment concentrations of Hg at the AK sites were lower than those for the CA sites; however, AK invertebrates generally bioaccumulated more Hg than CA invertebrates. Conversely, Hg bioaccumulation was higher in CA fish. Even though ratios of total metal/acid volatile sulfides (AVS) in sediment were one to two orders of magnitude higher for the AK sites, bioaccumulation of these elements was much higher in fish from the CA sites. Bioaccumulation factors ([liver]/[sediment]) (BAFs) were highest at relatively clean sites (Bodega Bay and Monterey), indicating that elements were more bioavailable at these sites than from more contaminated locations. The observation of high BAFs for As in fish from Alaska and low BAFs for the California fish, but reversed for Cd, Hg, and Pb in this study, implies that differences in fish species are less important than the unique geochemical features at each site that control bioavailability and bioaccumulation and the potential sources for each element. Additionally, these data were also used to examine the metal depletion hypothesis, which describes the inverse relationship between elements and organic contaminants documented in some monitoring studies. Our results suggest that the enhanced bioavailability of the metals at some uncontaminated sites is the main determinant for the inverse correlation between metal and organic contaminants in tissue.

Acids↗
PubMed2005

Chlorinated hydrocarbon contaminants and metabolites in polar bears (Ursus maritimus) from Alaska, Canada, East Greenland, and Svalbard: 1996-2002.

A suite of chlorinated hydrocarbon contaminants (CHCs) including organochlorine pesticides (OCPs) and by-products, polychlorinated biphenyls (PCBs), and methyl sulfone (MeSO2) PCB and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) metabolites were determined in adipose tissue of 107 adult and sub-adult polar bears, almost exclusively females, sampled between 1996 and 2002 from populations spanning Arctic and Subarctic regions of Alaska, Canada, East Greenland, and Svalbard. The East Greenland and Svalbard populations of polar bears were distinguished by higher proportions of dichlorodiphenyldichloroethane (DDT)-related compounds, nonachlors, oxychlordane, and higher-chlorinated and persistent PCB congeners (hepta- to nona-chlorinated). Conversely, Alaska, the westernmost population of the North American Arctic, was characterized by higher proportions of relatively volatile compounds such as hexachlorocyclohexanes (HCHs) and pentachlorobenzene (PnCBz), lower-chlorinated PCB congeners (tri- to penta-chlorinated), and lower proportions of oxychlordane. Geometric mean (GM) with 95% confidence limits (CL) SigmaHCH concentrations were highest in Alaska male polar bear fat samples (GM 593; CL 363-909 ng g-1 lipid weight), SigmaDDT concentration were highest in East Greenland female samples (GM 309; CL 249-490 ng g-1 l.w.), and Sigma42PCB (GM 5972; CL 4637-9129 ng g-1 l.w.) and SigmaMeSO2-PCB (GM 198; CL 162-279 ng g-1 l.w.) concentrations were highest in female samples collected from Svalbard. The distribution of Sigma-chlordane-related compounds (SigmaCHL), SigmaCBz, mirex, and dieldrin was relatively uniform among the populations of polar bears investigated. The present 1996-2002 data of female polar bear fat samples was compared to spatial assessments of female polar bear fat samples collected between 1989 and 1993 from comparable populations. The two-point temporal comparisons showed a general decrease for age-adjusted mean concentrations of SigmaCHL, p,p'-DDE, Sigma42PCB, SigmaMeSO2-PCB and 3-MeSO2-p,p'-DDE over a period of approximately 10 years. However, concentrations of dieldrin were comparatively unchanged. Comparisons of present 2001-2002 concentrations in fat of female polar bears from Western Hudson Bay showed great consistency with temporal trends (1991-1999) previously reported for the same region, i.e. the apparent non-decreasing trend of SigmaCHL, beta-HCH, SigmaHCH and dieldrin, and the apparent declining trend for SigmaPCB. However, present concentrations of alpha-HCH and SigmaCBz were elevated, and SigmaDDT was notably lower in Western Hudson Bay samples compared to the last measurements in fat samples collected in 1999, which was not in accord with reported temporal trends for this region. As a result of their relatively high degree of contamination, East Greenland and Svalbard polar bears are at higher health risk of contaminant exposure among Arctic and Subarctic populations. In addition to continued biomonitoring, further research on health and population status is needed to evaluate the impact from chronic exposure of polar bear populations to CHCs and their metabolites.

Adipose Tissue↗
PubMed1995

Dietary change and obesity associated with glucose intolerance in Alaska Natives.

OBJECTIVE: To investigate frequency of food intake, body weight, and glucose intolerance in Alaska Natives. DESIGN: Height, weight, and random blood glucose levels were measured and a frequency-of-food-intake questionnaire was obtained. This questionnaire classified persons as consumers of indigenous foods or nonindigenous foods within three food groups. Those with a random blood glucose measurement > or = 6.72 mmol/L received an oral glucose tolerance test. SETTING: Community screening in 15 villages in Alaska. SUBJECTS: Nutrition screenings were done for 1,124 Alaska Native residents aged 20 years or older. An oral glucose tolerance test was done for 202 subjects. OUTCOMES MEASURED: Subjects were classified as consumers of indigenous or nonindigenous foods within three food groups. A diagnosis of non-insulin-dependent diabetes mellitus (NIDDM) was made on the basis of World Health Organization criteria. A determination of overweight was made on the basis of National Center for Health Statistics criteria. STATISTICAL ANALYSIS: A chi 2 test with Yates correction, t test, and linear regression, with two-sided P values. RESULTS: Athabascan Indians had twice the rate of NIDDM as Yup'ik Eskimos with significantly higher frequency of nonindigenous food intake, plus lower frequency of indigenous carbohydrate and fat intake. Subjects < or = 30 years old consumed significantly more nonindigenous protein and fat and low-nutrient-density carbohydrates than those > or = 60 years old. Persons who had glucose intolerance reported significantly greater consumption of nonindigenous protein and less seal oil. Incidence of overweight was significantly higher than was found 25 years ago. Participants with glucose intolerance were significantly more overweight than others. CONCLUSION: A pattern of increased frequency of nonindigenous protein, low-nutrient-density carbohydrate, and fat intake with less indigenous carbohydrate and fat consumption was found in subjects < or = 30 years old and in association with the higher rate of NIDDM found in the Athabascan Indians. Persons with glucose intolerance were significantly more overweight than others. APPLICATIONS: Although the nutritional value of indigenous foods for reducing disease risk should be promoted, nutrition education, especially among young adults, should also include building skills to select and prepare nonindigenous foods to attain a healthful diet. Although snacking is a concern, dietary fat was the most significant factor in obesity and NIDDM.

Adult↗
PubMed1998

Risk factors for pediatric tuberculosis infection and disease after household exposure to adult index cases in Alaska.

OBJECTIVES: To determine risk factors for pediatric tuberculosis infection and active tuberculosis. STUDY DESIGN: We examined medical records from multiple sources for all 282 children younger than 15 years in Alaska during the period 1987 to 1994 who were household contacts of an adult with culture-positive pulmonary tuberculosis. RESULTS: Infection developed in 25% of the children and progressed to active disease in 9.6%. Risk factors for pediatric infection included exposure to a parent who had active tuberculosis and exposure to any adult with active tuberculosis who had a cough, smear positivity, or a left upper lobe (LUL) chest lesion (odds ratios, 2.1 to 2.8). Among the 71 children in whom infection developed, Alaska Natives and younger children were more likely to progress to active tuberculosis, as were children exposed to a parent who had active tuberculosis and children exposed to any adult who had a LUL chest lesion (odds ratios, 1.5 to 12). CONCLUSIONS: Although all children with household exposure to adults with active tuberculosis have a high risk of contracting the infection and disease, specific risk factors can be identified and differ for infection and disease. Alaska Natives have an increased risk of progression to disease once infected.

Adolescent↗
PubMed1998

Alaska Native cancer epidemiology in the Arctic.

Cancer incidence and its possible relation to environmental contaminants, including radiation, continues to be a perceived health threat for the arctic-dwelling Alaska Native (Inupiat Eskimo) people despite the lack of a direct link to high-dose exposure. To better understand this concern, all known malignancies diagnosed in this population (n = 177) in three consecutive eight-year periods (1971-1994) were evaluated. The most recent average incidence rate (age-adjusted to world standard population) of 315 per 100,000 (95% confidence interval, CI = 248-382) represents a 33% surge (albeit non-significant) in Alaska Native cancer incidence over the initial period studied. The male rate 366 (95% CI = 266-466) for the same period exceeds the female rate 258 (95% CI = 169-347) by 42%. Two patterns of cancer incidence are seen at the village level. One, a 24 y upward trend found in the villages of Barrow, Point Hope and Kaktovik (combined rate of increase significant [P = 0.047]) associated with lung cancer; and the other, a stable trend over the past 16 y, associated with colon and rectal cancer. Lung cancer is the predominant cancer by site and is primarily a male disease. The recent male lung cancer incidence rate of 137 (95% CI = 73-201) exceeds the female rate by greater than five times. Total lung cancer cases are primarily confined to four villages where the incidence significantly (P = 0.0043) exceeds the remaining population. The major female cancers are colon/rectal and breast with cancer of the cervix virtually eliminated. Breast cancer is found primarily in two villages where its excess is significant (P = 0.025). Inupiat Eskimo cancer epidemiology is unique, differing from both the Alaska Native and other Circumpolar populations. At present, this uniqueness cannot be explained by an overt environmental contaminant exposure. Although tobacco very likely plays a central role, it by itself cannot fully explain the extremely high male lung cancer rate and why only specific villages are affected. Genetic predisposition and environmental factors may play a synergistic role as cofactors. A cooperative investigative effort with the Inupiat population is indicated and may go a long way in reducing cancer concern in the region.

Adolescent↗
PubMed2000

Recruitment of American Indians and Alaska Natives into clinical trials.

Challenges in recruiting American Indians and Alaska Natives into cancer clinical trials are addressed in this article. Researchers, health care providers, and American Indian and Alaska Native patients face significant communication barriers when prevention or treatment trials are designed or implemented. For researchers, the challenges lie in understanding the cultural distinctiveness of individual tribes, coping with the family orientation of Indian subjects, dealing with the lack of standardized research measures, and defining the subject's pathway in seeking and obtaining healing and health care services. For providers, the challenges center on patient-provider communication, illness beliefs, transportation, and sociocultural barriers. This article explores these complex issues and offers recommendations for researchers and health care providers on conducting research in American Indian and Alaska Native populations.

Alaska↗
PubMed2002

Reassessment of the hydrocarbons in Prince William Sound and the Gulf of Alaska: identifying the source using partial least-squares.

There has been considerable exchange in the literature regarding the source of the background hydrocarbons in Prince William Sound and the Gulf of Alaska. Page and coworkers suggest oil-based sources while Short and coworkers suggest coal. The multivariate statistical methodology of partial least-squares (PLS) has been used to reassess the percentage contribution of coal, seep oil, shales, and rivers to the hydrocarbon loading in the Gulf of Alaska. Data have kindly been provided by Short (NOAA) and Page (Bowdoin College, for Exxon), and these have been analyzed using selected sites as sources in order to develop signatures. These signatures are based on 40 and 136 compounds, respectively, and include the PAH and terpane/sterane biomarkers in the case of the Exxon data. The principal components describing these sources are then fitted to the data for other sites around the Prince William Sound (PWS) and Gulf of Alaska (GoA) to determine the proportion of the variability described by each source. Using the Exxon data, a mixed source of coal, seep oil, eroding shales, and rivers (1 and 2) sources described approximately 13%, 18%, 24%, 26%, and 20%, respectively, of the variance in PWS and GoA data. The rivers 1 signature was very similar to that of coal, while rivers 2 was more similar to the eroding shales. New coal data (Short, unpublished work) also indicated considerable overlap with the Exxon seep oil. With the NOAA data, spatial plots of the explained variance indicate that the prespill background has a wide range of explained fits. There is considerable overlap in the signatures developed from the data, and Coomans' Plots identify those compounds which are the most diagnostic: for the Exxon seep oil signature, naphthalene and methyl- and dimethylnaphthalene are the best markers, whereas for the NOAA prespill background, Exxon coals and shales are best defined by the larger PAHs such as benzo[ghi]perylene. The evidence suggests mixed sources whose contributions vary significantly across the sampling area.

Alaska↗