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PubMed2001

Perinatal care regionalization and low birth weight infant mortality rates in Alaska.

OBJECTIVE: The purpose of this study was to determine the extent to which the failure of non-tertiary care hospitals to appropriately triage and refer pregnant women and newborns contributes to low birth weight infant death in Alaska. STUDY DESIGN: Birth certificates from 1993 to 1997 were reviewed for all 2809 infants who were born at less than 2500 g. Death certificates and maternal and infant medical charts were reviewed for all 168 infant deaths that occurred during this time. RESULTS: Mother-infant pairs who received all care at Alaska's single tertiary care center had a lower mortality rate than those who received some care at a non-tertiary care center (risk ratio, 1.5; 95% confidence interval, 0.86-2.6). Despite this, only 4% of deaths among low birth weight infants (all <1500 g) were associated with care decisions at non-tertiary centers; none of these deaths involved intentional inappropriate retention of infants or mothers. CONCLUSION: Further emphasizing perinatal care regionalization (including for infants 1500-2499 g birth weight) is unlikely to substantially decrease low birth weight infant mortality rates.

Alaska↗
PubMed2003

25-hydroxyvitamin D levels among healthy children in Alaska.

OBJECTIVE: To determine vitamin D levels among children 6 to 23 months old receiving services from Women, Infants, and Children (WIC) programs in Alaska. Study design During 2001 and 2002, we recruited 133 children receiving services at seven WIC clinics, administered a risk factor questionnaire, and collected blood. RESULTS: Fifteen (11%) and 26 (20%) children, respectively, had vitamin D levels <15 (considered abnormal) and 15 to <25 ng/mL (low normal). Compared with other children, children who still breast-fed were more likely to have a vitamin D level <15 ng/mL (relative risk [RR], 12; 95% confidence interval [CI], 3.6-39) or 15 to <25 ng/mL (RR, 3.6; 95% CI, 1.9-6.8) than > or =25 ng/mL. Among 41 still breast-feeding children, 14 (34%) took supplemental vitamins, and six (18%) were reported to have received vitamins every day. CONCLUSIONS: Vitamin D deficiency is prevalent in Alaska. Breast-feeding in the absence of adequate vitamin D supplementation is the greatest risk factor.

Alaska↗
PubMed2006

Ice-age endurance: DNA evidence of a white spruce refugium in Alaska.

Paleorecords offer key information for evaluating model simulations of species migration in response to forecast climatic change. However, their utility can be greatly compromised by the existence of glacial refugia that are undetectable in fossil records (cryptic refugia). Despite several decades of investigation, it remains controversial whether Beringia, the largely unglaciated area extending from northeastern Siberia to the Yukon Territory, harbored small populations of certain boreal tree species during the last glaciation. Here, we present genetic evidence for the existence of a glacial refuge in Alaska that helps to resolve this long-standing controversy. We sequenced chloroplast DNA (cpDNA) of white spruce (Picea glauca), a dominant boreal tree species, in 24 forest stands across northwestern North America. The majority of cpDNA haplotypes are unique, and haplotype diversity is relatively high in Alaska, arguing against the possibility that this species migrated into the region from areas south of the Laurentide Ice Sheet after the end of the last glaciation. Thus, white spruce apparently survived long glacial episodes under climatic extremes in a heterogeneous landscape matrix. These results suggest that estimated rates of tree migration from fossil records may be too high and that the ability of trees to track anthropogenic warming may be more limited than previously thought.

Alaska↗
PubMedDate not supplied

Pap prevalence and cervical cancer prevention among Alaska Native women.

The goals of the Alaska Native Women's Health Project (WHP) were to determine the following: (1) Pap prevalence based on chart review before and during an intervention period; (2) the level of understanding of cancer and cancer screening services with emphasis on cervical cancer; (3) use and satisfaction with current health maintenance services; and (4) improvement in knowledge and cancer screening rates following intervention. A random sample of 481 Alaska Native (Eskimo, Aleut, Indian) women living in Anchorage were interviewed face to face about their understanding of cancer risk factors (tobacco use, sexually transmitted diseases (STDs), reproductive issues), cancer screening examinations (Pap test, breast self-examination (BSE), breast exam by a provider, mammography), and their attitudes about health care and health care services. Sixty-two percent of control women were documented to have had at least one Pap test within the 3-year period prior to the beginning of the study; however, only 9% were documented to have had annual Pap screening. The intervention included distribution of educational materials, counseling on any woman's health issue, special evening clinics, and reminders (mail/phone call) of scheduled Pap appointments.

Adult↗
PubMed2005

Iqmik--a form of smokeless tobacco used by pregnant Alaska natives: nicotine exposure in their neonates.

OBJECTIVE: To determine the concentration of nicotine and cotinine in maternal blood and neonatal cord blood among pregnant Alaska Native women and to assess the neonates for neurobehavioral effects. METHODS: In a nonrandomized, clinical observational pilot trial, 60 pregnant Alaska Native women were enrolled for assessment of Iqmik (a mixture of leaf tobacco and ash) and other tobacco use during pregnancy and at delivery. Neonatal cord blood, nicotine and cotinine concentrations were obtained, and neonatal neurobehavioral effects were assessed using the Lipsitz scale. RESULTS: At delivery, there were 22 subjects who reported using only Iqmik, and 10 who used other tobacco products. Subjects who reported using only Iqmik prior to delivery had higher concentrations of cotinine (167+/-116 vs. 81+/-100) in maternal blood (rank sum test, p=0.036) and higher concentrations of nicotine (8.4+/-7.3 vs. 4.4+/-5.1, p=0.048) and cotinine (153+/-115 vs. 70+/-95, p=0.048) in cord blood compared to subjects who reported using other tobacco products. Neurobehavioral signs as assessed by the Lipsitz score were increased in neonates born to mothers using only Iqmik (3.7+/-1.8, p=0.011), or to mothers using other tobacco products (3.4+/-1.4, p=0.034) compared to neonates born to women who reported no tobacco use (1.8+/-1.4). CONCLUSIONS: Mothers who use Iqmik and their neonates have higher cotinine concentrations compared to mothers who use cigarettes and/or other forms of tobacco. Neurobehavioral signs occur in neonates born to women who use Iqmik but also in neonates born to mothers who use other forms of tobacco during pregnancy.

Adult↗
PubMedDate not supplied

Responding to victimized Alaska Native women in treatment for substance use.

High rates of physical and sexual abuse have been found among Alaska Native women entering a residential treatment program in Fairbanks, Alaska. Little information, however, has been available that describes the nature of such abuse and its relationship to treatment outcome. This article describes the extent of such abuse and reviews factors involved in its onset. The implications of the findings are discussed with an emphasis on how they can be applied to enhance treatment outcome.

Adolescent↗
PubMed1999

Characterization of a multidrug-resistant clone of invasive Streptococcus pneumoniae serotype 6B in Alaska by using pulsed-field gel electrophoresis and PspA serotyping.

Antimicrobial susceptibility, pneumococcal surface protein A (PspA) serotyping, and pulsed-field gel electrophoresis (PFGE) were used to evaluate clonal relatedness among 66 invasive isolates of Streptococcus pneumoniae serotype 6B collected during 1982-1996 from patients in Alaska. Thirty-seven (56%) of the isolates had penicillin minimal inhibitory concentration values >/=0.125 microgram/mL and were resistant to at least 1 other antibiotic. Fourteen PspA serotypes were observed; PspA 16 was the most common (35%). Forty-five (68%) of the 66 isolates shared common and highly related PFGE patterns using 3 enzymes. Twenty-six (58%) of the isolates with common PFGE patterns were from Native Alaskan children </=2 years of age residing in 1 region of Alaska. Alaskan serotype 6B had distinct PFGE patterns, compared with the South African 6B-8 and Spanish 6B-2 multidrug-resistant clones, suggesting that the Alaskan 6B isolates were distinct from these other pneumococcal 6B clones but were genetically related to each other [corrected].

Adolescent↗
PubMed2004

Community-onset methicillin-resistant Staphylococcus aureus associated with antibiotic use and the cytotoxin Panton-Valentine leukocidin during a furunculosis outbreak in rural Alaska.

BACKGROUND: Community-onset methicillin-resistant Staphylococcus aureus (CO-MRSA) reports are increasing, and infections often involve soft tissue. During a CO-MRSA skin infection outbreak in Alaska, we assessed risk factors for disease and whether a virulence factor, Panton-Valentine leukocidin (PVL), could account for the high rates of MRSA skin infection in this region. METHODS: We conducted S. aureus surveillance in the outbreak region and a case-control study in 1 community, comparing 34 case patients with MRSA skin infection with 94 control subjects. An assessment of traditional saunas was performed. S. aureus isolates from regional surveillance were screened for PVL genes by use of polymerase chain reaction, and isolate relatedness was determined by use of pulsed-field gel electrophoresis (PFGE). RESULTS: Case patients received more antibiotic courses during the 12 months before the outbreak than did control subjects (median, 4 vs. 2 courses; P=.01) and were more likely to use MRSA-colonized saunas than were control subjects (44% vs. 13%; age-adjusted odds ratio, 4.6; 95% confidence interval, 1.7-12). The PVL genes were present in 110 (97%) of 113 MRSA isolates, compared with 0 of 81 methicillin-susceptible S. aureus isolates (P<.001). The majority of MRSA isolates were closely related by PFGE. CONCLUSION: Selective antibiotic pressure for drug-resistant strains carrying PVL may have led to the emergence and spread of CO-MRSA in rural Alaska.

Adolescent↗
PubMed2006

Hepatitis B virus genotypes in Alaska Native people with hepatocellular carcinoma: preponderance of genotype F.

BACKGROUND: The development of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection has been associated with specific HBV genotypes and the presence of specific mutations. METHODS: From a cohort of Alaska Native people with chronic HBV infection, we genotyped 47 patients with HCC and 1129 patients without HCC, and we tested patients with HCC and control patients for mutations in the basal core promoter and precore regions. RESULTS: Genotype F was found in 68% of patients with HCC, versus 18% of those without HCC (P<.001). For patients with genotype F, the median age at diagnosis of HCC was lower than that for patients with other genotypes (22.5 vs. 60 years, respectively; P=.002). Overall, there were no significant differences in the number of basal core promoter and precore region mutations between patients with HCC and control patients. CONCLUSIONS: We found a significant association between genotype F and the development of HCC among Alaska Native people with chronic HBV infection but no significant association between HCC and basal core promoter or precore mutations in genotype F.

Adolescent↗
PubMedDate not supplied

Childhood origins of depression: evidence from native and nonnative women in Alaska and the Russian Far East.

Explanations for depression usually implicate contemporaneous stressors, although biologic predispositions and childhood violence may also serve as precursors. This study evaluates the relative influence of contemporaneous stressors and both intrafamilial and interethnic violence experienced in childhood. Logistic regression is applied to data collected from a random sample of 355 women aged 20-89 in 1993 who lived in Chukotka and Kamchatka in the Russian Far East and in the Aleutians and the Northwest Alaskan Native Association region of Alaska. Although two contemporaneous stressors influence the likelihood of depression, intrafamilial violence experienced in childhood and, for natives of both Alaska and the Russian Far East, childhood emotional abuse by nonnatives exhibit dramatically more important effects that do not decay with time. These findings point to a violence-induced biologic mechanism for depression in adulthood. They also warrant interventions that extend their focus to the subtle forms of emotional violence that members of one ethnic group may inflict on another and to the social power relationships that may give these forms of violence a lifelong impact.

Adolescent↗
PubMed1995

Use of capture-recapture analyses in fetal alcohol syndrome surveillance in Alaska.

Capture-recapture methods were used to estimate the prevalence of fetal alcohol syndrome among Alaska Natives born during the period 1982-1989. Potential cases were identified through an Indian Health Service (IHS) patient case file, a pediatric practice case file, and Medicaid claims from private physicians. A total of 74 Alaska Native children aged 3-10 years were identified with a notation of fetal alcohol syndrome by a physician in a medical record. Because not all of these cases had supporting documentation regarding the syndrome, they were classified as possible cases. Of these possible cases, 50 met all five criteria for chart verification of the syndrome: physician notation of fetal alcohol syndrome, growth deficiency, facial features of the syndrome, central nervous system impairment, and a maternal history of alcohol abuse. These data provided observed prevalence rates of chart-verified fetal alcohol syndrome of 3.1 per 1,000 live births for children born 1982-1985 (age 7-10 years), and 2.0 per 1,000 live births for children born 1986-1989 (age 3-6 years). Capture-recapture analyses were conducted using cases identified by IHS and private physicians. These analyses estimated a prevalence of the syndrome of 3.8 per 1,000 live births for children born 1982-1985, and 3.1 per 1,000 live births for children born 1986-1989. Based on the capture-recapture predicted number of cases, the IHS case file ascertained a greater percentage of cases among the older cohort (75%) than among the younger cohort (56%). These data illustrate the use of capture-recapture analyses in identifying the extent to which observed trends in rates may reflect differences in cases ascertainment over time (or by birth cohort). The application of capture-recapture in fetal alcohol syndrome surveillance, however, requires careful attention to the underlying assumptions of capture-recapture methods.

Alaska↗
PubMed1989

Ethnicity of socioeconomic status? Health differences between elder Alaska Natives and whites.

We investigated self-reported health difference between elderly Alaska Natives and whites, and attempted to distinguish the effects of socioeconomic factors from other facets of ethnicity, upon health and physical well-being. Results indicate that elderly Alaska Natives suffer from a greater variety of impairments than do whites. Health differences disappear, however, in multivariate analyses that control for socioeconomic factors. Income, education, gender, and age appear to be more important determinants of health status among the elderly than ethnicity, per se.

Aged↗
PubMed1985

Molecular epidemiology of plasmid-mediated ampicillin resistance in Haemophilus influenzae type b isolates from Alaska.

Native Alaskans have a high incidence of disease caused by invasive Haemophilus influenzae type b and represent an isolated population for epidemiological study. We used plasmid DNA analysis and subtyping of outer membrane proteins as markers to characterize 29 ampicillin-resistant, invasive strains and seven ampicillin-resistant, noninvasive strains of this organism from distinct geographic regions. All 36 strains produced beta-lactamase; 34 strains transferred resistance by conjugation. Seven of the 36 strains harbored detectable plasmid DNA: four had a molecular mass of 40 MDa, and three had a molecular mass of 3 MDa. Furthermore, 20 transconjugants had a similar large plasmid, and four had a similar small plasmid. Ten of 12 transconjugants with either the large, small, or undetectable plasmid DNA were able to retransfer resistance. Transformation of resistance was successful with two large plasmids. DNA-DNA hybridization studies revealed that 33 of 36 strains had DNA homology. Restriction endonuclease digestion of 10 large plasmids revealed five patterns; identity was evident within a geographic region, and similarity existed between regions. Seven restricted plasmids demonstrated an identical pattern with a small beta-lactamase probe. Ampicillin resistance in these isolates from Alaska is primarily due to a common, 40-MDa conjugative plasmid that mediates beta-lactamase production, a finding which differs from that for ampicillin-resistant plasmids isolated elsewhere in the United States. Despite variable outer membrane protein profiles of the distinct strains of H. influenzae type b, the plasmids shared significant DNA homology. It appears that a common genetic element was responsible for the dissemination of this phenotype for resistance in Alaska.

Alaska↗
PubMed1986

Invasive Haemophilus influenzae type b disease in Alaska: background epidemiology for a vaccine efficacy trial.

In a previous study we demonstrated that Alaskan Eskimos had the highest endemic incidence of invasive Haemophilus influenzae type b (Hib) disease. In 1980 we established a prospective surveillance program for all invasive Hib disease throughout Alaska to characterize additional epidemiological features of disease in Native Alaskans to plan for a vaccine efficacy trial and define the epidemiology of Hib disease in all population groups in the state. For the three-year period, 1980-1982, 287 confirmed episodes of invasive Hib disease occurred. For children less than five years of age, the incidences for Eskimos, Indians, and non-Natives were 705, 401, and 129 cases per 100,000 population, respectively. The Native population represents only 16% of the population of Alaska but has 51% of all invasive Hib disease. Disease differed significantly among Eskimos, Indians, and non-Natives with regard to risk, age of onset, disease type, antibiotic susceptibility of strains, and regional incidence, but mortality and seasonal occurrence were similar. For Native Alaskans the cumulative Hib disease risk for the first two years of life was 4% (range, 1%-7% by region). This high endemic disease risk, concentrated in the first two years of life, provides a unique opportunity to prospectively evaluate the protective efficacy of a vaccine in a randomized, blinded, and placebo-controlled trial. Such a trial was initiated in December 1984.

Adolescent↗
PubMed1994

The prevalence of cervical infection with human papillomaviruses and cervical dysplasia in Alaska Native women.

Alaska Native women historically have high rates of sexually transmitted diseases (STDs) and invasive cervical cancer. Their prevalence of cervical infections with human papillomavirus (HPV) in relation to cervical dysplasia was determined with a commercial dot hybridization test for seven HPV genotypes. Type-specific HPV DNA, similarly distributed between genotype groups 16/18 and 31/33/35, was detected in 234 cervical specimens (21%) from 1126 Alaska Native women seeking routine care and colposcopy or from population-based lists. The prevalence of HPV DNA declined with age and increased with sexual activity and cigarette smoking. It was unrelated to use of oral contraceptives or condoms or to STDs. Relative risks associating HPV with increasing severe grades of cervical dysplasia increased markedly with HPV infection, up to 7.1 for high-risk genotypes 16/18 and 14.4 for coinfection with 31/33/35. These genotypes were detected in 8% of women without dysplasia seeking routine care. Screening for strain-specific HPV DNA may identify women at highest risk for cervical neoplasia.

Adolescent↗
PubMed1994

Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska 1986-1990.

From January 1986 through December 1990, 672 cases of invasive pneumococcal disease were identified. From these, 574 pneumococcal isolates were recovered from normally sterile sites (blood, cerebrospinal and pleural fluid); 92% were serotypes represented in the 23-valent pneumococcal polysaccharide vaccine. The most common serotypes from children < 2 years old were 4, 6B, 9V, 14, 18C, 19F, and 23F, recovered from 83% of Alaska Native and 75.1% of nonnative children with invasive disease. Moderate penicillin resistance (MIC, 0.1-1.0 micrograms/mL) was found in 3.8% of isolates. All were sensitive to chloramphenicol, vancomycin, rifampin, ceftriaxone, cefotaxime, cephalothin, and cefaclor. However, in the Yukon-Kuskokwim Delta region, 16.9% of isolates were moderately resistant to penicillin, and 10.8% were resistant to erythromycin and 6.2% to trimethoprim-sulfamethoxazole; the number resistant to two or more antibiotics increased significantly during surveillance. All multiply resistant isolates were serotype 6B, and all were from Alaska Native patients < 2 years old.

Adolescent↗
PubMed1977

Bacterial meningitis in southwestern Alaska.

Between July 1, 1971, and June 30, 1974, thirty-nine cases of bacterial meningitis were diagnosed at the Alaska Native Health Service Hospital at Bethel, Alaska. Thirty-two (82%) occurred in infants less than one year of age. Haemophilus influenzae (H. influenzae) was the predominant causative agent, and was isolated from 23 (72%) of the 32 patients under one year of age. The annual incidence of H. influenzae meningitis in the Bethel area was 63/100,000, and the annual incidence of H. influenzae meningitis in children less than five years of age was 474/100,000 cases.

Adult↗
PubMedDate not supplied

Asthma prevalence among American Indian and Alaska Native children.

OBJECTIVES: Although asthma is the most common chronic childhood illness in the United States, little is known about its prevalence among American Indian and Alaska Native (AI/AN) children. The authors used the latest available household survey data to estimate the prevalence of asthma in this population. METHODS: The authors analyzed data for children ages 1 through 17 years from the 1987 Survey of American Indians and Alaska Natives (SAIAN) and the 1987 National Medical Expenditure Survey (NMES). At least one member of each AI/AN household included in the SAIAN was eligible for services through the Indian Health Service. RESULTS: The weighted prevalence of parent-reported asthma was 7.06% among 2288 AI/AN children ages 1-17 (95% CI 5.08, 9.04), compared with a US estimate of 8.40% for children ages 1-17 based on the 1987 NMES (95% CI 7.65, 9.15). The AI/AN sample was too small to yield stable estimates for a comparison between AI/AN children and all US children when the data were stratified according to household income and metropolitan vs non-metropolitan residence. The unadjusted asthma prevalence rates were similar for AI/AN children and for children in the NMES sample. CONCLUSIONS: In 1987, the prevalence of parent-reported asthma was similar for AI/AN children in the SAIAN sample and for children in the NMES sample. More recent data are needed to better understand the current prevalence of asthma among AI/AN children.

Adolescent↗