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PubMedDate not supplied

Clinical outcomes for newborn intensive care in Alaska.

Recent clinical outcomes for the Newborn Intensive Care Unit (NICU) at Providence Alaska Medical Center based on Alaska Neonatology's Clinical Outcomes Database are presented. There has been a decrease in overall mortality, with much of the improvement occurring in babies from 22 to 25 weeks gestation in the years 1998--2002. There has also been a decrease in the incidence of severe intraventricular hemorrhage / periventricular leukomalacia. Earlier discharge of babies has also been documented, as measured by post conceptual age at discharge. No improvement in the incidence of retinopathy of prematurity and nosocomial sepsis were seen. Rates of chronic lung disease and babies going home in oxygen have increased. Outcomes that have failed to improve are the focus of quality improvement initiatives. Clinical outcome information systems such as the NICU outcomes database are essential for assessing clinical performance and provide the foundation and focus for quality improvement initiatives.

Alaska↗
PubMed2005

Lead exposure from indoor firing ranges among students on shooting teams--Alaska, 2002-2004.

CDC recognizes blood lead levels (BLLs) of >/=25 microg/dL in adults and >/=10 microg/dL in children aged </=6 years as levels of concern; no similar level has been set for older children and adolescents. During 2002-2004, the Alaska Environmental Public Health Program (EPHP) conducted lead-exposure assessments of school-based indoor shooting teams in the state, after a BLL of 44 microg/dL was reported in a man aged 62 years who coached a high school shooting team in central Alaska. This report summarizes the results of the EPHP investigation of potential lead exposure in 66 members of shooting teams, aged 7-19 years, who used five indoor firing ranges. The findings suggest that improper design, operation, and maintenance of ranges were the likely cause of elevated BLLs among team members at four of the five firing ranges. Public health officials should identify indoor firing ranges that have not implemented lead-safety measures and offer consultation to reduce the risk for lead exposure among shooters, coaches, and employees.

Adolescent↗
PubMed1992

Comparison of Montana and Alaska isolates of Echinococcus multilocularis in gerbils with observations on the cyst growth, hook characteristics, and host response.

To assess its biological distinctness, an isolate of Echinococcus multilocularis from Montana was compared with an isolate from Alaska in gerbils (Meriones unguiculatus) by means of intraperitoneal inoculations with protoscoleces. The cysts formed by the Montana isolate were entire, hyaline, and translucent, whereas those produced by the Alaska isolate were granular, yellowish, and opaque. Vesicles of the Montana isolate were larger, produced protoscoleces more slowly but in greater numbers, and required a longer period to develop surfacial germ cell protrusions, which were of smaller size. Also delayed was invasion of the laminate layer by granulocytes and macrophages, and a longer time was required for the appearance of pulmonary metastases. The 2 isolates differed also in characteristics of rostellar hooks, those from the Montana isolate being fewer and larger, often with accessory hooks.

Alaska↗
PubMedDate not supplied

Peptic ulcer disease in the Alaska Natives: a four-year (1967-1971) retrospective study.

A four-year retrospective study of peptic ulcer disease in the Alaska Native confirmed our suspicion of a decreased ratio of duodenal to gastric ulcers. There were 92 patients with duo-denal ulcers, 75 with gastric ulcers, 6 with carcinoma of the stomach and 1 with gastric sarcoma. Ulcer disease in the Alaska Natives differs from ulcer disease among the Southwestern Indians as reported by Sievers.

Alaska↗
PubMed1991

Experience with standardized protocols in hypothermia, boom or bane? The Alaska experience.

The geography, climate and population of Alaska place practitioners with a variety of skills in the position of initially caring for sick or injured people. The state of Alaska has developed an Emergency Medical Services (EMS) system which is responsible for the training of personnel, equipment, and other aspects of pre-hospital care. In 1982, the EMS produced protocols for the treatment of hypothermia (1). These protocols recommend the specific treatment preferred for each level of skill--from the lay public and first responders through physicians. Revised in 1989, they have been well accepted throughout the state. The protocols have clarified what can be a somewhat confusing subject. The result has been treatment in the field, in smaller clinics, and in hospitals that conforms more to an accepted standard of care-relieving people from having to resolve certain debated aspects of care. A recent survey of prehospital personnel and physicians involved in prehospital care confirmed the usefulness of the protocols.

Alaska↗
PubMedDate not supplied

Surveillance for tuberculosis in Alaska, 1986.

The incidence of tuberculosis in the Native population in Alaska (92.2/100,000) continues to be higher than the U.S. tuberculosis incidence (9.3/100,000). This paper describes tuberculosis surveillance in Alaska and estimates the "predictive value positive" for cases recorded by the surveillance system during 1986. (Predictive value positive refers to the proportion of all people identified who actually have the disease.) Active surveillance components included an itinerant chest clinic and survey chest roentgenography program, epidemiologic case investigations, and skin testing. Passive components included cases reported by health-care providers and the U.S. Immigration and Naturalization Service. Half of all new cases were reported by health-care providers. Only 42% of cases were bacteriologically confirmed (vs 87% nationwide) suggesting that some cases may have been false positives. many cases did not have a contact investigation completed. Recommendations to improve the surveillance system include: 1) following the Centers for Disease Control/American Thoracic Society diagnostic criteria more closely, 2) increasing the number of cases which have contact investigations completed, and 3) targeting surveillance activities towards high risk subgroups such as Southeast Asian immigrants.

Alaska↗
PubMedDate not supplied

p53 is not mutated in hepatocellular carcinomas from Alaska Natives.

Hepatocellular carcinoma is common among Alaska Natives. The known risk factor in this population is hepatitis B viral infection; fungal toxins, including aflatoxin B1, have not been detected in foodstuffs. In this series of 14 patients (including 4 siblings and 2 second cousins), 3 patients were less than 12 years old at diagnosis of hepatocellular carcinoma, 8 patients were 13-24 years old, and 3 patients were more than 60 years old. Since p53 mutations occur in 29% of hepatocellular carcinomas worldwide, we tested the tumors for p53 mutations and serum samples for anti-p53 antibodies. Serum samples from these 14 patients did not contain detectable levels of anti-p53 antibodies. Loss of heterozygosity within the p53 locus was not detected in any of 9 informative cases. Immunohistochemical analysis for p53 protein accumulation was negative in all of 11 tumors. DNA sequence analysis of 12 tumor samples showed no evidence of p53 mutation in the highly conserved regions included in exons 5-8. These data, combined with one case from a previous report, indicate a mutation frequency of 0 of 13, which differs significantly from the worldwide frequency of 29% (chi 2 3.9; P = 0.048). These results indicate that liver carcinogenesis among Alaska Natives occurs independently of a traditional p53 pathway. The familial clustering and early onset in this population strongly suggest an inherited genetic predisposition to develop liver cancer. Germline mutations in a tumor suppressor or a cancer susceptibility gene are likely. Future studies of these samples should include investigations of candidate suppressor or susceptibility genes which map to chromosomal regions commonly deleted in liver cancers.

Adolescent↗
PubMed1994

A comparison of the diets of Siberian Chukotka and Alaska Native adults and recommendations for improved nutrition, a survey of selected previous studies.

Diet plays an important role in the development of common diseases among Northern indigenous people, i.e. heart disease, cancer, diabetes and iron deficiency. Their unique diets may contribute to or protect from these diseases. The diets consumed by Siberian Chukotka Natives (Russia) and Alaska Natives (United States) during the 1980's are described. Traditional foods still play a major role, although the extent of their use varies. Alaska Natives' diets are more "western" than are those of Chukotka Natives. They consumed a greater proportion of kilocalories as carbohydrates and fat than Chukotka Natives. Coastal Chukotka Natives had lower average serum LDL-cholesterol and higher HDL-cholesterol levels than tundra Chukotka Natives, despite their high fat and kilocalorie intakes. Dietary recommendations common to both groups are presented which encourage the use of traditional foods as the foundation of the diet supplemented with western type foods of appropriate quality and quantity.

Adult↗
PubMed1994

Risk for traumatic injuries from helicopter crashes during logging operations--southeastern Alaska, January 1992-June 1993.

Helicopters are used by logging companies in the Alaska panhandle to harvest timber in areas that otherwise are inaccessible and/or unfeasible for conventional logging (because of rugged terrain, steep mountain slopes, environmental restrictions, or high cost). The National Transportation Safety Board (NTSB) investigated six helicopter crashes related to transport of logs by cable (i.e., long-line logging*) that occurred in southeastern Alaska during January 1992-June 1993 and resulted in nine fatalities and 10 nonfatal injuries. This report presents case investigations of these incidents.

Accidents, Occupational↗
PubMed1994

Diurnal and seasonal rhythms of melatonin, cortisol and testosterone in interior Alaska.

The diurnal variations in the secretory patterns of melatonin, cortisol and testosterone were studied in a Fairbanks, Alaska population who were unadapted to the extreme light variations of the North. Statistically significant variations in hormonal levels were found in both diurnal and seasonal rhythms. Prominent findings included unusually high levels of cortisol at 0200 and 0800 in the fall and elevated daytime levels (1030) of melatonin in the winter. These results indicate a delayed phase secretory pattern when compared to the normal pattern at lower latitudes. These findings imply possible underlying physiological causes for the high incidence of behavior disorders such as depression and alcoholism in Alaska and circumpolar environments in general.

Adult↗
PubMedDate not supplied

Pneumococcal vaccination in a remote population of high-risk Alaska Natives.

In response to an increasing prevalence of serious pneumococcal disease among adult Alaska Natives of northwest Alaska, a 3-year program was begun in 1987 to identify residents of that remote region who were at high risk for developing invasive pneumococcal disease, to determine their pneumococcal vaccination status, and to deliver vaccine to at least 80 percent of those at risk. After reviewing public health nursing and Indian Health Service data bases, the authors identified 1,337 persons, 20 percent of the 6,692 residents of the region, at high risk for invasive pneumococcal infection, defined either by having a specific chronic disease or by age criteria. Cardiovascular disease and alcoholism were the two most common chronic diseases. Only 30 percent of those determined to be at high risk had received one or more doses of pneumococcal vaccine previously. Half of those persons had received their most recent vaccination 6 or more years earlier. The program used both customary and innovative methods to deliver 23-valent polysaccharide vaccine to 1,046 of those at high risk (78 percent), including 388 persons who were revaccinated. At the completion of the project, 1,123 persons, 84 percent of those at high risk, had received at least 1 dose. They included 1,088 persons, 81 percent of those at high risk, with vaccination within the previous 5 years as a result of the project, compared with a 15-percent rate prior to the vaccination phase of the project. The program demonstrated that high levels of vaccination against pneumococcal disease, exceeding Year 2000 objectives of 60 percent, are attainable in a remote rural Alaskan population.

Adolescent↗
PubMed1993

Linking multiple data sources in fetal alcohol syndrome surveillance--Alaska.

Although fetal alcohol syndrome (FAS) is a major preventable cause of mental retardation in the United States (1), surveillance for this problem is subject to at least five constraints: difficulty in identifying the syndrome at birth (2); the subjective nature of the diagnosis; variability in the severity and type of conditions associated with FAS; age-specific variations in the expression of the phenotype; and the lack of specificity in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for FAS. Previous studies have documented high rates of FAS among American Indians and Alaskan Natives (ANs) (3,4). To better ascertain cases of FAS in Alaska and to determine the prevalence of this problem among ANs, the Alaska Department of Health and Social Services (ADHSS), the Indian Health Service (IHS), and CDC linked and analyzed data from state sources (i.e., birth and death certificates and Medicaid claims), an IHS case file, and a private pediatric practice case file. This report summarizes the findings from this analysis and presents a preliminary minimum FAS prevalence rate for ANs.

Adolescent↗
PubMed1996

Measles outbreak among school-aged children--Juneau, Alaska, 1996.

An outbreak of measles among school-aged children occurred in Juneau, Alaska, from February 16 through April 25, 1996. Of 63 confirmed cases, 47 were serologically confirmed, and virus was cultured from 15; a total of 41 (65%) were among school-aged children (i.e., aged 6-18 years). This report summarizes results of the epidemiologic investigation conducted by the Division of Public Health, Alaska Department of Health and Social Services (ADPH), which found evidence of measles transmission at schools despite high rates of coverage with one dose of measles-containing vaccine (MCV).

Adolescent↗
PubMedDate not supplied

The health of American Indian and Alaska Native women.

By a number of quantity and quality of life measurements, the health and well-being of many American Indian and Alaska Native women falls short of that reported for other women in the United States. Poor socioeconomic conditions, lack of education, cultural barriers, and other factors (some not easily measured) contribute to the enduring poor health status of this population-despite the availability of free health care for many. Free health care alone does not promise a healthy population, especially when the types of free health care are limited, inadequately funded, or have limited focus on preventive care. This paper attempts to pinpoint some of these issues as it relates to the health status of American Indian and Alaska Native women.

Adolescent↗
PubMed1996

American Indians and Alaska Natives--overview of the population.

THE ESTIMATED TWO MILLION American Indians and Alaska Natives, while sharing certain genetic traits, belong to groups with distinct social, cultural, political, and biomedical attributes. They share with certain other ethnic minorities high poverty rates, low educational attainment, increased susceptibility to certain diseases, and elevated mortality rates. Hypertension has been reported less frequently among American Indians compared to other U.S. groups, but is increasing in frequency, is strongly associated with obesity and diabetes, and is synergistically associated with diabetes in the etiology of end-stage renal disease. The first priority for dealing with hypertension among American Indians is to maximize efforts toward control. The Indian Health Service (IHS) provides such an opportunity, which is not as readily available to other minorities. In addition to controlling hypertension, areas of fruitful investigation include studies relating hypertension to acculturation, physiology of peripheral adrenergic vasoreceptors, salt and water metabolism, and prevention or amelioration of end-stage renal disease. Understanding some of these basic processes will prove valuable for American Indians and Alaska Natives as well as the entire population.

Alaska↗
PubMed1996

Responses of embryonic and larval inland silversides, Menidia beryllina, to a water-soluble fraction formed during biodegradation of artificially weathered Alaska North Slope crude oil.

Weathered Alaska North Slope crude oil (ANS 521) was stirred for 2 and 14 days in 20 per thousand salinity sterile seawater or for 14 days in seawater with nutrients and a group of three (GO3) microorganisms from Prince William Sound, Alaska, that were capable of biodegrading hydrocarbons. A total of 0.65 and 0.69 mg/L water soluble fraction (WSF) of neutral fraction hydrocarbons was recovered from the 2- and 14-day stirred sterile systems, respectively. In comparison, a total of 7.5 mg/L WSF neutral fraction hydrocarbons was recovered from systems containing ANS 521 that were stirred and biodegraded by the GO3 microbes for 14 days. Toxicity/teratogenicity tests were conducted with neutral fraction hydrocarbons recovered from the sterile and biodegraded systems using embryonic inland silversides, Menidia beryllina. Hydrocarbons from the sterile systems did not cause statistically significant teratogenic responses at concentrations of 1%, 10%, and 100% (w/v) of recovered fractions (redissolved in 20 per thousand salinity sterile seawater). Counts of heart contraction rates were significantly lower (alpha</=0.05) at the 100% WSF concentration of hydrocarbons on days 5 and 6 of embryogenesis. In contrast, recovered and redissolved neutral fraction hydrocarbons from ANS 521, that were biodegraded for 14 days, caused statistically significant (alpha</=0.05) teratogenic responses at the 1, 10, and 100% WSF concentrations. Measurement of heart contraction rates showed statistically significant (alpha</=0.05) reductions at the 100% WSF concentration on days 2 through 6 of embryogenesis, compared to controls.

Analysis of Variance↗
PubMed2002

Effects of fractions from biodegraded Alaska North Slope crude oil on embryonic inland silversides, Menidia beryllina.

Embryonic inland silversides, Meinida beryllina, were exposed to neutral, water-soluble fractions (WSFs) resulting from microbial degradation of artificially weathered Alaska North Slope (ANS) crude oil. Three individual microbes obtained from Prince William Sound, Alaska, and designated Phe#6 (enriched on phenanthrene), Hexaco#2 (enriched on the straight-chain alkane, hexacosane), and EI2V (grown by enrichment on Bushnell-Haas medium containing 0.2% pristane, a branched alkane) were used to individually biodegrade weathered ANS crude oil for 14 days in darkness in 20-L glass carboys containing nutrient enriched, sterilized 20% salinity sea water at 20 +/- 1 degrees C. Neutral WSFs resulting from biodegradation of ANS (lot 521) by each microbe were recovered and weighted. Neutral WSFs recovered were: 1.76 mg/L for Phe#6, 1.85 mg/L for Hexaco#2, and 13.02 mg/L for the EI2V microbe. Embryo toxicity and teratogenicity tests revealed that exposure of embryos to the WSFs from the EI2V incubation (with a total recovered neutral fraction approximately seven times greater than the Phe#6 and Hexaco#2 incubations) resulted in the most severe responses in craniofacial, cardiovascular, and skeletal organ systems. The total neutral WSFs recovered from the EI2V biodegradation of weathered ANS 521 were subfractionated into saturated (eluted with hexane), aromatic (eluted with CH2Cl2), polar (eluted with ethyl ether), and recombined (saturated + aromatic + polar) fractions. Developing fish embryos were then exposed to each subfraction and the recombined subfractions. The polar subfraction and recombined subfractions proved to be the most embryo toxic and teratogenic. They resulted in statistically significant (p < or = 0.05) responses (compared to controls) for craniofacial, cardiovascular, skeletal, and total severity effects in one or both tests with these subfractions.

Animals↗
PubMed1998

Preliminary observations on responses of embryonic and larval Pacific herring, Clupea pallasi, to neutral fraction biodegradation products of weathered Alaska North Slope oil.

Weathered Alaska North Slope crude oil (ANS 521) was subjected to biodegradation in vigorously stirred incubations for 14 days at 15 +/- 1 degrees C in 20/1000 salinity sterilized seawater, amended with nutrients and inoculated with a hydrocarbon-degrading microorganism (EI2V) isolated from an oil-contaminated beach in Prince William Sound, Alaska. A total of 13.7 mg/L water-soluble neutral fraction (WSF) was recovered from the incubation of weathered ANS 521. Toxicity/ teratogenicity tests were conducted with WSF recovered from the biodegradation system using embryonic and larval Pacific herring, Clupea pallasi. Exposures were begun at 4, 48, and 96 h postfertilization of herring eggs. Exposure concentrations were 1, 10, and 100% of the original concentration of WSF recovered from incubations (redissolved in 20/1000 salinity sterile seawater at 15 +/- 1 degrees C). Sterile 20/1000 salinity seawater without the addition of redissolved neutral fraction was used as a control. Significant (p < or = 0.05) embryo mortality or teratogenic responses were observed at WSF concentrations of 10 and 100%. On days 5 through 8 of embryogenesis, counts of heart contraction rates were significantly lower (p < or = 0.05) at the 100% WSF concentration for embryos exposed beginning at 4 and 48 h postfertilization. Grow-out of larvae from selected exposures was conducted. High mortality was noted in larvae exposed to the 10% WSF concentration beginning at 4 and 48 h postfertilization. Most of these larvae died 5 to 8 days after hatching when they elicited vertebral displacements at a time concurrent with the onset of feeding behavior.

Animals↗