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PubMed2004

Prevalence of asthma and chronic respiratory symptoms among Alaska Native children.

STUDY OBJECTIVES: To quantify the prevalence and impact of chronic respiratory symptoms among predominantly Alaska Native (AN)/American Indian (AI) middle school students. DESIGN: School-based prevalence assessment using the International Study of Asthma and Allergy in Children survey, with supplemental video material and added questions about productive cough, exposure to tobacco smoke, and the functional impact of symptoms. SETTING: The Yukon-Kuskokwim delta region of western Alaska. PARTICIPANTS: A total of 466 children in the sixth to ninth grades, 81% of whom are AN/AI (377 children). INTERVENTIONS: No study intervention. RESULTS: Among the 377 AN/AI children, 40% reported one of the following three categories of chronic respiratory disease: physician-diagnosed asthma, 7.4%; asthma-like symptoms (ALS) without an asthma diagnosis, 11.4%; and chronic productive cough (CPC) without asthma diagnosis or symptoms, 21.5%. Symptom prevalence differed substantially between the largest town in the region and rural villages. After an adjustment for demographic factors, exposure to environmental tobacco smoke, active tobacco smoking, and self-report of atopy, village residents were 63% less likely to have ALS (p = 0.009), and had a twofold greater risk of CPC (p < 0.001) compared to children living in the town. Children with respiratory symptoms experienced sleep disturbances and accessed clinic visits for respiratory problems more often than did asymptomatic children. CONCLUSIONS: Chronic respiratory symptoms are very common among AN children. CPC is an important nonasthmatic respiratory condition in this population. The differing patterns of respiratory illness within this region may help to elucidate the specific risk factors for asthma and chronic bronchitis in children.

Adolescent↗
PubMed2004

Components of successful HIV/AIDS case management in Alaska Native villages.

Case management is a valuable support service for HIV/AIDS patients, but little is known about the elements of case management that contribute to success for Alaska Natives living in remote rural villages. This study used qualitative data from 18 key informants (social services/health workers, family members, and tribal leaders) to identify the elements of successful case management. Two major categories dominated the analysis. First, the case management organization possessed attributes, such as location, coordination, and support for professionals, that contributed to a positive case management experience. Second, the case manager had both knowledge/professional skills and values with personal capabilities that contributed to positive experiences. These components of successful case management can be integrated into existing and future case management programs for Alaska Natives to improve client level outcomes.

Adult↗
PubMed1989

A macro-level fetal alcohol syndrome prevention program for Native Americans and Alaska Natives: description and evaluation.

Presented here are a detailed description and outcome evaluation of a comprehensive, macro-level Fetal Alcohol Syndrome prevention program for Native Americans and Alaska Natives. The program was designed to provide native communities throughout the United States with the knowledge, skills and strategies to initiate primary, secondary and tertiary prevention measures on their own. The key to the program was the training of a cadre of trainers/advocates in all local Native American and Alaska Native communities served by the Indian Health Service. These people were then supported and assisted in their efforts through a variety of means. Evaluation results of knowledge gained indicate that the local trainers had substantial success in imparting FAS information to a variety of audiences (prenatal groups, school children and community groups). Further, the evaluation samples also indicate that the knowledge was retained by the groups over time (2-4 months) and that there may have been some general diffusion of knowledge among peers in local communities. This program is presented in the hope that it will be replicated and improved upon by similar programs using this model as a base.

Adult↗
PubMed2001

Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska.

OBJECTIVE: To determine the contribution of prone sleeping, bed sharing, and sleeping outside an infant crib to sudden infant death syndrome (SIDS). METHODS: We conducted a retrospective descriptive study of all SIDS cases in Alaska from January 1, 1992, through December 31, 1997. Reviewed data sources included maternal and infant medical records, autopsy reports, birth and death certificates, police and state trooper death scene investigations, and occasionally home interviews. RESULTS: The death certificate identified SIDS as a cause of death for 130 infants (cause-specific infant mortality rate: 2.0 per 1000 live births). Among infants for whom this information was known, 113 (98%) of 115 were found in the prone position, sleeping outside an infant crib, or sleeping with another person. By contrast, 2 (1.7%) were found alone and supine in their crib (1 of whom was found with a blanket wrapped around his face). Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non-drug-using parent on an adult nonwater mattress was identified. CONCLUSION: Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib. In the absence of other risk factors, SIDS deaths associated with parental bed sharing were rare.

Adult↗
PubMed2003

Inadequate supervision as a cause of injury deaths among young children in Alaska and Louisiana.

OBJECTIVE: Inadequate supervision of children has contributed to injuries. However, the association of inadequate supervision with injury events in children has not been quantified. The purpose of this study was to describe and quantify the role of inadequate supervision of children in injury deaths. METHODS: Injury deaths among children aged 0 to 6 years in Alaska during 1993 to 1995 and Louisiana during 1994 were classified using 10 child safety standards to assess the role of parent/caregiver supervision in the circumstances of injury death. RESULTS: The leading categories of injury death for both states combined were motor vehicle injury and fire-related injury. Of the classifiable injury deaths in both states (157 [77%] of 203 deaths), the most commonly violated safety standard was "children should be supervised by a responsible care provider" (64 deaths [41%]). Of these deaths, the caregiver was absent in 38%, and the caregiver increased the danger to the child in 17%. Male injury deaths more typically involved a supervision standard violation. Drowning and pedestrian deaths typically involved a supervision standard violation, whereas asphyxiation, homicide, and occupant motor vehicle injury deaths did not. CONCLUSION: Alaska and Louisiana child injury deaths were mostly attributed to preventable violations of 10 child safety standards, most commonly the supervision standard. The methods in this report were useful in identifying target populations and causes of death, which can be used to plan and implement interventions to improve supervision of children.

Alaska↗
PubMed2003

Infectious disease hospitalizations among American Indian and Alaska native infants.

OBJECTIVE: To describe the burden and trends in hospitalizations associated with infectious diseases among American Indian and Alaska Native (AI/AN) infants. METHODS: First-listed infectious disease hospitalizations and hospitalization rates among AI/AN infants and infants in the general US population from 1988-1999 were analyzed by using Indian Health Service/tribal hospital discharge data and the National Hospital Discharge Survey data, respectively. RESULTS: Infectious disease hospitalizations accounted for 53% of all AI/AN infant hospitalizations and approximately 43% of all US infant hospitalizations during 1988-1999. The annual hospitalization rate for infectious diseases among AI/AN infants declined from 27,486 per 100,000 infants in 1988 to 14,178 per 100,000 infants in 1999. However, the rates for AI/AN infants within the Alaska, Southwest, and Northern Plains regions remained higher than that for the general US infant population at the end of the study period. Lower respiratory tract infection hospitalizations accounted for almost 75% of AI/AN infant infectious disease hospitalizations, and the lower respiratory tract infection hospitalization rate for AI/AN infants was twice that for US infants. CONCLUSIONS: Although infectious disease hospitalization rates for AI/AN infants have declined, AI/AN infants continue to have a higher infectious disease burden than the general US infant population.

Age Factors↗
PubMed2003

Sequelae of severe respiratory syncytial virus infection in infancy and early childhood among Alaska Native children.

OBJECTIVE: In 1993-1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999-2001 to determine whether children who are hospitalized with RSV at <2 years of age are more likely to develop chronic respiratory conditions. METHODS: For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified. RESULTS: Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma. CONCLUSIONS: Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood.

Age Factors↗
PubMed2003

MCH released in a novel pheromone dispenser prevents spruce beetle, Dendroctonus rufipennis (Coleoptera: Scolytidae), attacks in south-central Alaska.

Field tests of 3-methyl-2-cyclohexen-1-one (MCH), the antiaggregation pheromone of the spruce beetle, Dendroctonus rufipennis Kirby, were conducted in south-central Alaska in stands of Lutz spruce, Picea x lutzii Little, and Sitka spruce, P. sitchensis (Bong.) Carr. The deployment of MCH in a novel releaser significantly reduced trap catches and spruce beetle attacks on standing live spruce by 96 and 87%, respectively. The results of this study demonstrate the first successful field test of MCH in Alaska for the prevention of spruce beetle attacks on standing, live spruce.

Alaska↗
PubMedDate not supplied

An adenovirus linked to mortality and disease in long-tailed ducks (Clangula hyemalis) in Alaska.

An adenovirus was isolated from intestinal samples of two long-tailed ducks (Clangula hyemalis) collected during a die-off in the Beaufort Sea off the north coast of Alaska in 2000. The virus was not neutralized by reference antiserum against known group I, II, or III avian adenoviruses and may represent a new serotype. The prevalence of the virus was determined in live-trapped long-tailed ducks at the mortality site and at a reference site 100 km away where no mortality was observed. Prevalence of adenovirus antibodies in serum samples at the mortality site was 86% compared to 10% at the reference site. Furthermore, 50% of cloacal swabs collected at the mortality site and only 7% of swabs from the reference site were positive for adenoviruses. In 2001, no mortality was observed at either of the study areas, and virus prevalence in both serum and cloacal samples was low, providing further evidence that the adenovirus was linked to the mortality event in 2000. The virus was used to infect long-tailed ducks under experimental conditions and resulted in lesions previously described for avian adenovirus infections and similar to those observed in long-tailed duck carcasses from the Beaufort Sea. The status of long-tailed ducks has recently become a concern in Alaska due to precipitous declines in breeding populations there since the mid-1970s. Our findings suggest that the newly isolated adenovirus is a disease agent and source of mortality in long-tailed ducks, and thus could be a contributing factor in population declines.

Adenoviridae↗
PubMed2006

Associations between the Alaska Steller sea lion decline and commercial fisheries.

The Steller sea lion (SSL) population in Alaska was listed as threatened under the Endangered Species Act in 1990. At that time, several procedural restrictions were placed on the commercial fisheries of the region in an effort to reduce the potential for human-induced mortality on sea lions. Several years have elapsed since these restrictions were put into place, and questions about their efficacy remain. In an effort to determine whether or not fisheries management measures have helped the SSL population to recover, estimates of the fishing activity of the Bering Sea/Gulf of Alaska commercial fisheries in the vicinity of individual SSL rookeries and SSL population trends at those rookeries were made using data from the National Marine Fisheries Service (NMFS) Fisheries Observer Program and Steller Sea Lion Adult Count Database. Fisheries data from 1976-2000 were analyzed in relation to SSL population counts from 1956-2001 at 32 rookeries from the endangered western stock. Linear regression on the principal components of the fisheries data show that a positive correlation exists between several metrics of historical fishing activity and the SSL population decline. The relationship is less consistent after 1991, supporting a hypothesis that management measures around some of the rookeries have been effective in moderating the localized effects of fishing activity on SSL.

Alaska↗
PubMedDate not supplied

Biogeochemistry of a treeline watershed, northwestern Alaska.

Since 1950, mean annual temperatures in northwestern Alaska have increased. Change in forest floor and soil temperature or moisture could alter N mineralization rates, production of dissolved organic carbon (DOC) and organic nitrogen (DON), and their export to the aquatic ecosystem. In 1990, we began study of nutrient cycles in the 800-ha Asik watershed, located at treeline in the Noatak National Preserve, northwestern Alaska. This paper summarizes relationships between topographic aspect, soil temperature and moisture, inorganic and organic N pools, C pools, CO2 efflux, growing season net N mineralization rates, and stream water chemistry. Forest floor (O2) C/N ratios, C pools, temperature, and moisture were greater on south aspects. More rapid melt of the soil active layer (zone of annual freeze-thaw) and permafrost accounted for the higher moisture. The O2 C and N content were correlated with moisture, inorganic N pools, CO2 efflux, and inversely with temperature. Inorganic N pools were correlated with temperature and CO2 efflux. Net N mineralization rates were positive in early summer, and correlated with O2 moisture, temperature, and C and N pools. Net nitrification rates were inversely correlated with moisture, total C and N. The CO2 efflux increased with temperature and moisture, and was greater on south aspects. Stream ion concentrations declined and DOC increased with discharge. Stream inorganic nitrogen (DIN) output exceeded input by 70%. Alpine stream water nitrate (NO3-) and DOC concentrations indicated substantial contributions to the watershed DIN and DOC budgets.

Alaska↗
PubMed1993

Clinical hypertension and its interaction with diabetes among American Indians and Alaska Natives. Estimated rates from ambulatory care data.

OBJECTIVE: To estimate the prevalence of clinical hypertension and describe the coexistence with diabetes in American Indian and Alaska Native communities. RESEARCH DESIGN AND METHODS: A cross-sectional study of outpatient visits for hypertension and diabetes over a 1-yr period (1 October 1986 to 30 September 1987) in IHS facilities was conducted. RESULTS: The 1987 estimated age-adjusted prevalence of diagnosed hypertension for this group was 10.9/100 for people > or = 15 yr of age. Thirty-seven percent of diabetic patients were diagnosed with hypertension. The relative risk of hypertension in the diabetic populations compared with the nondiabetic population varied from 4.7 to 7.7 among the different IHS areas. CONCLUSIONS: Despite high rates of diabetes and obesity, hypertension rates were relatively low among American Indians and Alaska Natives when compared with other ethnic groups in the U.S.

Adolescent↗
PubMed1994

Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska Natives.

OBJECTIVE: To examine the association of seal oil and salmon consumption with impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) among Alaska Natives. RESEARCH DESIGN AND METHODS: Screening was performed on 666 Yup'ik Eskimos and Athabaskan Indians > or = 40 years old in 15 villages. Self-administered questionnaires were used to obtain partial food frequency data. A case was defined as IGT or NIDDM, either newly discovered or known. Newly discovered cases (11 patients with NIDDM and 17 with IGT) were determined by random blood glucose testing followed by a 2-h 75-g oral glucose tolerance test (OGTT) for those with values > or = 6.72 mmol/l or for subjects with unconfirmed histories of glucose intolerance. Known cases included 26 patients with NIDDM and 1 with IGT. Control subjects had random blood glucoses < 6.72 or normal OGTT results. RESULTS: Compared with less-than-daily consumption, both daily seal oil (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1-0.8) and daily salmon consumption (OR 0.5, CI 0.2-1.1) were associated with a lower prevalence of glucose intolerance, controlling for age, ethnicity, body mass index, and sex. The effects were similar when limited to newly discovered cases: OR 0.3, CI 0.1-1.3 for seal oil and OR 0.4, CI 0.1-1.3 for salmon. Consumption of seal oil at least five times per week was required to reduce risk. CONCLUSIONS: Consumption of seal oil and salmon, high in omega-3 fatty acids, appears to lower the risk of glucose intolerance and is a potentially modifiable risk factor for NIDDM in Alaska Natives.

Adult↗
PubMed2002

Regional variation in cardiovascular disease risk factors among American Indians and Alaska Natives with diabetes.

OBJECTIVE: To compare by region risk factors for cardiovascular disease among American Indian populations with diabetes. RESEARCH DESIGN AND METHODS: Trained providers from 185 federal, urban, and tribally operated facilities reviewed the records from systematic random samples of the patients included in the local diabetes registries in the 1998 Indian Health Service (IHS) Diabetes Care and Outcomes Audit. Selected measures of cardiovascular risk were aggregated by region and adjusted to calculate regional rates for patients <45 years of age (n = 2,595) and those aged > or =45 years (n = 8,294). RESULTS: Among the younger group of patients with diabetes, the rates of elevated HbA(1c) (> or =9%) and tobacco use varied significantly among regions. High rates of obesity (78%) and elevated HbA(1c) (56%) were found in the Southwest. High rates of tobacco use (55%) but the lowest rates of elevated HbA(1c) (27%) were found in Alaska. Among patients aged > or =45 years, all measures including rates of proteinuria, cholesterol > or =200 mg/dl, and mean blood pressure > or =130/85 varied significantly among all regions. Tobacco use was highest in the Great Lakes (44%) and Great Plains (42%) regions and lowest in the Southwest (14%) and Colorado Plateau (8%) regions. Proteinuria was found most frequently in the Southwest (35%), Colorado Plateau (30%), and Pacific regions (35%). Older individuals with diabetes were more likely than younger individuals to have proteinuria and blood pressure > or =130/85. CONCLUSIONS: American Indians and Alaska Natives with diabetes carry a large burden of potentially modifiable cardiovascular risk factors, but there is significant regional variation.

Adult↗
PubMedDate not supplied

Drug use in very rural Alaska villages.

The Alaska Native Preschool Project was centered in the Head Start Programs of two typical Alaska native villages near the Bering Sea. Data were collected over 5 years, 1990 to 1995, from preschool parents (N = 342) with surveys, a panel of villagers (N = 25 to 30) using qualitative interviews; villagers using participant observation; and a limited review of public records. The villages typify the changing life of Alaskan villagers who live in the Bering Straits area. Qualitative data indicated that a number of problems were associated with drug and alcohol use in the villages. The level of smokeless tobacco use from surveys in the previous month among preschool parents (41%) was self-reported to be almost 10 times greater than the national level reported in the 1995 National Household Survey. The use of marijuana reported by preschool parents in the previous month was almost 3 times higher than the 1995 National Household Survey estimates (19 vs 6.7%). Tobacco use in the previous month was reported at over 56%, a level that was over 1 1/2 times the level of use at 34.7% estimated from the 1995 National Household Survey. For 26-34 year olds, previous month alcohol use was lower for the village parents than estimated from the 1995 National Household Survey (38 vs 63%). The self-reported levels of other drug use among preschool parents were very low compared with overall United States rates.

Adult↗
PubMed2003

Diabetes among Alaska Natives: a review.

This review summarizes the published information on diabetes mellitus and gestational diabetes among Alaska Natives. The most recently published age-adjusted prevalence was 28.3/1000 in 1998. There is evidence of a steadily increasing prevalence, documented both by cross sectional screening studies and patient registry methods. The overall incidence rates in 1986-1998 of lower extremity amputation (6.1/1000) and renal replacement therapy (2.1/1000) appear to be lower than those in other Native American populations in the United States. Incidence of stroke and MI in 1986-1998 varied widely by ethnic group and gender with Eskimo women having the highest rate of stroke (19.6/1000), and Aleut men the highest rate of MI (14/1000). The overall mortality among diabetic Alaska Native people in 1986-1993 (43.2/1000) was somewhat lower than that in other US diabetic populations, with heart disease being the most common cause of death. A high rate of gestational diabetes (6.7%) was reported in one region in 1987-88, but this appeared to decline following nutritional education intervention. In screening studies, the prevalence of abnormal glucose tolerance has been found to be positively associated with body mass index and negatively associated with daily seal oil or salmon consumption and higher levels of physical activity. Observations on the prevalence and relationships among other factors in the insulin resistance syndrome are summarized. Suggestions for prevention of diabetes and further studies are presented.

Adult↗
PubMed2003

Post-operative deepvein thrombosis is infrequent in Alaska Natives.

OBJECTIVES: The expected rate of deep vein thrombosis (DVT) after laparotomy or major joint surgery has been reported to be 20 to 50% for unprophylaxed non-native patients. DVT prophylaxis for surgical patients at the Alaska native Medical Center has typically not been offered as the perceived rate of DVT and pulmonary embolism in our patient population has been very low. Retrospective analysis of positive venous duplex scans at our institution revealed only four cases of post-operative DVT during a two-year interval. This study was designed to document the actual rate of post-operative DVT in Alaskan natives not provided with routine DVT prophylaxis. STUDY DESIGN: Prospective cohort study of DVT in open abdominal, open knee, open hip and pelvic fracture surgery patients at the Alaska native Medical Center from 1999-2001. METHODS: The day prior to expected discharge, we performed venous duplex ultrasonography on 67 patients with open abdominal surgery, major open knee or hip surgery, or pelvic fracture who received no DVT prophylaxis. Some patients included in the study were also asked questions about their consumption of marine mammals and fish, and the native blood quanta was estimated in all patients using existing data bases. RESULTS: Sixty percent of the study population was determined to be at high risk for DVT using standard risk stratification methods. Dietary habits varied widely, but were largely reported as being "traditionally" native. Nearly all patients had 50% or more "native blood". Only one of 67 patients developed a documented post-operative DVT. CONCLUSIONS: Post-operative deep vein thrombosis in Alaskan natives not provided with routine DVT prophylaxis is rare. The data does not provide a clear indication as to why Alaskan natives may be at decreased risk for post-operative DVT.

Adult↗
PubMed2005

Concentrations of selected persistent organochlorine contaminants in store-bought foods from northern Alaska.

OBJECTIVES: We address marine and terrestrial mammal blubber, liver, muscle, kidney, heart, tongue, maktak and maktaaq (epidermis and blubber from bowhead, beluga whales, respectively), and fish muscle and livers, as commonly consumed tissues in subsistence communities across northern Alaska in the context of organochlorine (OC) contamination of store-bought foods. Human exposure to contaminants from biota, as part of a subsistence diet, has been superficially evaluated in numerous studies (focused on liver and blubber), but are limited in the type of tissues analyzed, and rarely consider the contaminants in the alternatives (i.e., store-bought foods). STUDY DESIGN: Concentrations from published literature on selected persistent organochlorine contaminants (OCs) in eight tissues of the bowhead whale and other biota (1) were compared to store-bought foods evaluated in this study. RESULTS: As expected, store-bought foods had lower concentrations of OCs than some tissues of the marine mammals (especially blubber, maktak, and maktaaq). However, blubber is rarely eaten alone and should not be used to give consumption advice unless considered as a portion of the food item (i.e., maktak). This study indicates that the store-bought food alternatives have detectable OC concentrations (e.g., < 0.01 to 22.5 ng/g w.w. for hexachlorobenzene) and, in many cases, have greater OC concentrations than some subsistence food items. Many wildlife tissues had OC concentrations similar to those quantified in local store-bought food. CONCLUSIONS: Switching from the traditional diet to western store-bought foods will not always reduce exposure to OCs. However, raw blubber-based products are clearly more contaminated with OCs due to lipid content. A detailed profile of traditional/country foods and western foods consumed by subsistence communities of northern Alaska is required to address chronic exposure in more detail for the diverse sources of foods (subsistence use and commercially available) and the widely varying concentrations of contaminants reported therein. This should be combined with biomonitoring people dependent upon subsistence foods. Further assessment of essential and non-essential elements, emerging contaminants (e.g. brominated flame retardants), etc. should be conducted in order to improve our understanding of the differences and similarities between wildlife and store-bought foods.

Alaska↗