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PubMed1993

Hospital resource utilization by American Indians/Alaska Natives for alcoholism and alcohol abuse.

Previous work examining the issue of alcoholism and alcohol abuse among American Indians and Alaska Natives can be broadly categorized as either descriptions of the consumption patterns and behaviors of specific tribes or mortality studies, focusing on deaths due to alcoholism, alcohol abuse, chronic liver disease, or cirrhosis. A major shortcoming of previous studies has been that they have not looked at the burden this problem has imposed upon the system of health care delivery for this minority population. By using an International Classification of Diseases, Ninth Revision, Clinical Modification taxonomy of diagnostic codes developed by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) and the national Indian Health Service (IHS) inpatient database for direct and contract admissions, utilization patterns for 43 IHS facilities were investigated. The period of study was 1980-1988, and our case definition included any individual 14 years and older who had any mention upon discharge of an alcohol-related diagnosis (ARD). For the 9-year period under investigation, 43,302 adult inpatient admissions occurred at the 43 IHS facilities for ARD. These admissions accounted for an overall estimated per annum rate of 13.7% of the adult inpatient days. In addition, age and gender specific discharge rates for ARD were estimated and compared to reported ARD discharge rates of the United States civilian population prepared by the NIAAA using the National Hospital Discharge Survey over the period 1979-1988. In contrast, the IHS discharge rates for ARD were three times greater than reported ARD discharge rates for the United States civilian population.

Adolescent↗
PubMed2003

Hypertension in older urban Native-American primary care patients.

OBJECTIVES: To examine hypertension and its management in a population of older urban American Indians and Alaska Natives (AI/ANs). DESIGN: Retrospective cohort study using medical record review. SETTING: Urban health clinic serving predominantly AI/ANs in the Pacific Northwest. PARTICIPANTS: Five hundred twenty-four AI/ANs aged 50 and older seen between 1994 and 1995. MEASUREMENTS: Frequency of diagnosed hypertension, undiagnosed hypertension, comorbid conditions, hypertension treatment, control, and quality of care. RESULTS: The prevalence of diagnosed hypertension was 38%, and the prevalence of possible undiagnosed hypertension was 23%. Patients with diagnosed hypertension were more likely to be obese (age-adjusted odds ratio (OR) = 3.5), have diabetes mellitus (DM) (OR = 2.2), depression (OR = 1.7), heart disease (OR = 3.8), or renal disease (OR = 5.6) than patients without hypertension. Undiagnosed hypertension was inversely associated with number of health problems (OR = 0.8). Eighty-one percent of diagnosed patients were treated pharmacologically, but no factors associated with nontreatment were identified. Diuretic and beta-blocker usage was low. Patients with DM used angiotensin-converting enzyme inhibitors more frequently than patients without DM (OR = 2.4). Blood pressure was well controlled in 37%, with men being less well controlled than women (OR = 0.5). Serum cholesterol, creatinine, and retinal screening were performed more often than urinalyses or electrocardiograms. Lifestyle-modification counseling was uncommon. Number of health problems was the most common factor associated with screening tests for end-organ disease. CONCLUSION: Few studies have examined the care of older urban AI/ANs. Improvements are needed in adherence to recommendations for the detection, management, and monitoring of hypertension and its complications in older urban AI/ANs.

Aged↗
PubMed2006

Forty years in partnership: the American Academy of Pediatrics and the Indian Health Service.

Fifty years ago, American Indian and Alaska Native children faced an overwhelming burden of disease, especially infectious diseases such as pneumonia, meningitis, tuberculosis, hepatitis A and B, and gastrointestinal disease. Death rates of American Indian/Alaska Native infants between 1 month and 1 year were much higher than in the US population as a whole, largely because of these infectious diseases. The health care of American Indian/Alaska Native patients was transferred to the Department of Health, Education, and Welfare in 1955 and placed under the administration of an agency soon to be known as the Indian Health Service. The few early pediatricians in the Indian Health Service recognized the severity of the challenges facing American Indian/Alaska Native children and asked for help. The American Academy of Pediatrics responded by creating the Committee on Indian Health in 1965. In 1986 the Committee on Native American Child Health replaced the Committee on Indian Health. Through the involved activity of these committees, the American Academy of Pediatrics participated in and influenced Indian Health Service policies and services and, combined with improved transportation, sanitation, and access to vaccines and direct services, led to vast improvements in the health of American Indian/Alaska Native children. In 1965, American Indian/Alaska Native postneonatal mortality was more than 3 times that of the general population of the United States. It is still more than twice as high as in other races but has decreased 89% since 1965. Infectious diseases, which caused almost one fourth of all American Indian/Alaska Native child deaths in 1965, now cause <1%. The Indian Health Service and tribal health programs, authorized by the Indian Self-Determination and Education Assistance Act of 1976 (Pub L. 93-638), continue to seek American Academy of Pediatrics review and assistance through the Committee on Native American Child Health to find and implement interventions for emerging child health problems related to pervasive poverty of many American Indian/Alaska Native communities. Acute infectious diseases that once were responsible for excess morbidity and mortality now are replaced by excess rates resulting from harmful behaviors, substance use, obesity, and injuries (unintentional and intentional). Through strong working partnerships such as that of the American Academy of Pediatrics and the Indian Health Service, progress hopefully will occur to address this "new morbidity." In this article we document the history of the Indian Health Service and the American Academy of Pediatrics committees that have worked with it and present certain statistics related to American Indian/Alaska Native child health that show the severity of the health-status disparities challenging American Indian/Alaska Native children and youth.

Alaska↗
PubMed2001

Addressing psychosocial issues and problems of co-morbidity for Native American clients with substance abuse problems: a conference proceedings.

This proceedings consists of five papers presented at a conference titled: Psychosocial Issues and Problems of Co-Morbidity for Native American Clients with Substance Abuse Problems. The conference was held June 2-4, 1999, in Albuquerque New Mexico, and was hosted by the Native American Research and Training Center (NARTC) and the National Center for American Indian and Alaska Native Mental Health Research.

Adult↗
PubMed1996

The history and politics of US health care policy for American Indians and Alaskan Natives.

This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.

Alaska↗
PubMedDate not supplied

Measurement of antimicrobial susceptibility among invasive isolates of Streptococcus pneumoniae: comparison of the Etest with the standard agar dilution method.

High rates of invasive disease caused by Streptococcus pneumoniae occur in the Alaska Native population. Because of the wide use of empiric antibiotics to treat infection in rural regions of Alaska and concern over the emergence of pneumococcal strains now resistant to an increasing number of antibiotics we compared a simple strip system (Etest) for the measurement of antibiotic susceptibilities to the standard agar dilution method. Eighty-two pneumococcal isolates were tested by both methods. Overall, the Etest MICs of 91% of the isolates agreed within one log2 of the agar dilution, and 99.3% agreed within 2 log2 dilutions. There were no very major or major interpretative category discrepancies with the Etest for any antibiotic tested. There were 4.1% minor interpretative errors with the Etest, which generally occurred at the breakpoint between susceptible and intermediate resistance. The results indicated that the Etest was comparable to the agar dilution method for the measurement of antibiotic MICs for Streptococcus pneumoniae.

Alaska↗
PubMed2002

Screening for alcohol abuse among urban Native Americans in a primary care setting.

The authors examined the rate of and factors associated with alcohol abuse among 754 urban American Indian and Alaska Native primary care patients. Data were collected through a self-administered survey and by abstracting medical records. A total of 423 respondents (56 percent) screened positive for lifetime alcohol abuse, and 202 (27 percent) reported current alcohol abuse. A diagnosis of alcohol abuse was found in the medical records of 68 of the patients who screened positive (16 percent). Logistic regression analysis showed that being male, having been a victim of violence, and feeling depressed were associated with alcohol abuse. Further research is warranted to help clinicians detect and treat alcohol abuse in this special population.

Acculturation↗
PubMed2004

Prevalence and correlates of mental disorders among Native American women in primary care.

OBJECTIVES: We examined the lifetime and the past-year prevalence and correlates of common mental disorders among American Indian and Alaska Native women who presented for primary care. METHODS: We screened 489 consecutively presenting female primary care patients aged 18 through 45 years with the General Health Questionnaire, 12-item version. A subsample (n = 234) completed the Composite International Diagnostic Interview. We examined associations between psychiatric disorders and sociodemographic variables, boarding school attendance, and psychopathology in the family of origin. RESULTS: The study participants had high rates of alcohol use disorders, anxiety disorders, and anxiety/depression comorbidity compared with other samples of non-American Indian/Alaska Native women in primary care settings. CONCLUSIONS: There is a need for culturally appropriate mental health treatments and preventive services.

Adolescent↗
PubMed1983

Native healing in Alaska. Report from Serpentine Hot Springs.

Traditional Alaskan Native healing practices, specifically sweat bathing and hot springs bathing, have medical connotations in that they involve sociocultural factors important to practicing medicine among Alaskan Native people. At Serpentine Hot Springs in northwest Alaska, relief for arthritis, back pain, hip pain, headaches, skin rashes and other disorders was sought. The "treatment setting" was an informal bathhouse and bunkhouse and Eskimo tribal doctors and patients were assigned tasks related to healing. Continuity with traditional cultural patterns was achieved in several ways: meals tended to be traditional Eskimo fare, the predominant language spoken was Inupiaq and styles of interaction were Inupiat in character. All patients showed improvement. The experience reported herein is instructive for those seeking innovative approaches treating Native American groups.

Adult↗
PubMed2005

A survey of attendees at Native American health care conferences: knowledge, attitudes, and practices about cigarette smoking.

BACKGROUND: Cigarette smoking rates and related health consequences among Native Americans are the highest of any US ethnic group. METHODS: A sample of the attendees at American Indian and Alaska Native health care conferences participated in a survey about cigarette smoking. RESULTS: Of 162 respondents, 11.1% were current smokers, 7.5% of physicians were current smokers, and 80% were lifelong nonsmokers. The majority would ask a smoker to put out cigarettes and would not display ashtrays at home. Nearly all Native American physicians asked their patients about smoking and advised smokers to quit. Respondents were more likely to agree that smoking causes lung cancer (98.7%) as compared to knowing of the associations of smoking with cervical cancer (70.2%), depression (54.5%), and that it is more serious in women (55.2%; P < .01). CONCLUSIONS: Current smoking rates were low, and the physicians advised smokers to quit. However, there was less awareness about women's health problems that relate to cigarette smoking as compared to other health consequences of smoking.

Adult↗
PubMed1996

Overview of the Native American Cancer Conference III. Risk factors, outreach and intervention strategies.

BACKGROUND: Based on the lack of published information regarding Native Americans and cancer and the success of previous meetings, the Network for Cancer Control Research among American Indian and Alaska Native Populations (NCCR-AIANP) and the Native Hawaiian and American Samoan Cancer Research Network determined there was sufficient need to have annual national Native American cancer conferences. METHODS: The NCCR-AIANP, the Native Hawaiian and American Samoan Cancer Research Network, and the AMC Native American Cancer Research Program collaborated to organize the third national Native American cancer conference, "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies." RESULTS: The conference was held in Seattle, Washington, June 16-19, 1995. It provided a forum for scientific discussion and dissemination of information related to cancer prevention and control. CONCLUSIONS: Conference participants benefited from the topics presented and the diversity of the audience members. There continues to be a need to share what is happening in cancer research with this unique population and to address new issues of concern. A cancer conference seems to be a useful mechanism to provide such an opportunity.

American Samoa↗
PubMed2005

Characteristics associated with reservation travel among urban Native American outpatients.

The objectives of this study were to ascertain the extent of, and health-related characteristics associated with, travel to reservations in a low-income, urban American Indian and Alaska Native (AI/AN) population. We surveyed more than 500 AI/AN adults at a primary care clinic. Measures included time spent visiting a reservation during the past year, and sociodemographic, cultural, and clinical characteristics. More than half (52%) of the patients had not traveled, 34% had traveled up to 30 days, and 14% had spent more than 30 days traveling to reservations. Multivariate ordinal regression revealed that a strong Native American cultural identification, presence of lung disease, absence of thyroid and mental problems, and greater dissatisfaction with care were independently associated with more travel to reservations (p<or=0.05). This research begins to augment the paucity of information on such travel and its relationship to health status and use of health services among urban AI/ANs.

Adult↗
PubMed1998

Glucose tolerance and insulin-resistance syndrome among St. Lawrence Island Eskimos.

OBJECTIVES: Non-insulin-dependent diabetes mellitus (NIDDM) prevalence in Alaska Natives is rising but remains lower than the U.S. average. We conducted a screening study for diabetes mellitus and cardiovascular disease in a remote Yup'ik Eskimo community in Alaska. RESEARCH DESIGN AND METHODS: The study population included Siberian Yup'ik Eskimo residents of Gambell, Alaska, > or = age 40 years who underwent a 2 h 75 gm oral glucose tolerance test interpreted by WHO criteria. Other measurements included fasting serum insulin and lipid levels, bioimpedance body fat %, body-mass-index (BMI), waist-to-hip ratio (WHR), and blood pressure. RESULTS: Of 114 eligible subjects, 65 (57%) participated. These subjects had lower mean systolic or diastolic blood pressure, lower triglyceride, and higher mean HDL cholesterol levels compared to a similarly aged U.S. all races sample. The mean fasting insulin level of 50.9 pmol/L appeared low given the high mean BMI (27.2). Six subjects had NIDDM (9%, 95% CI 2%-16%) and eight had impaired glucose tolerance (IGT) (12%, 95% CI 4%-20%). Compared to normoglycemic subjects, diabetic subjects were more frequently female (83% vs 53%) and had higher mean systolic BP (138 mm Hg vs 117 mm Hg) than normoglycemic subjects. We used multiple regression to analyze associations between fasting insulin and either blood pressure or serum lipids, while adjusting for % body fat, WHR, age, sex, and antihypertensive medication use. Fasting insulin was significantly related to both diastolic blood pressure (p = .0430) and fasting serum triglyceride (p = .0182) but not to systolic BP, total cholesterol, or LDL and HDL subfractions. CONCLUSIONS: Although NIDDM prevalence was not high compared to non-Native U.S. residents, elements of the insulin-resistance syndrome exist in this subarctic population.

Adult↗
PubMed2005

A review of effective strategies for native women's breast health outreach and education.

BACKGROUND: This commentary provides a summary of a pilot study designed to assist the American Cancer Society in revising the Circle of Life breast health program for American Indians and Alaska Natives (AIANs). METHODS: Included are analyses of a literature review focusing on breast health outreach strategies among AIANs and in-depth interviews with breast health focus group facilitators. Over 70 AIAN breast or cervix cancer screening articles were reviewed, and approximately 20 focus group facilitators were interviewed. RESULTS AND CONCLUSIONS: A primary finding was that AIAN breast cancer outreach, education, and screening programs are most effective when community-driven and culturally relevant to local tribal nations and geographic regions.

Breast Neoplasms↗
PubMedDate not supplied

A national minority transplant program for increasing donation rates.

Since 1982, our group efforts demonstrated statistically significant improvements in minority donation rates which have applicability to all minority populations. As we continue to reach out to the various ethnic communities, we must listen to the needs of the community understanding that all ethnic communities have various beliefs and cultural barriers that will need to be addressed. For instance, the African-American population revealed the previously mentioned five obstacles to donation. The Hispanic population has revealed relatively the same fears to donation as the African-American population. In addition, the tribes within the Native-American population each have their own belief systems which will have to be addressed appropriately. The fears and obstacles toward donation within the Asians and Pacific Islanders and the Alaska Native groups are being defined. However, initial research reveals that all of the minority groups have very similar, if not the same, fears that were identified with the initial focus group in 1978. This simple methodology that has been established can ultimately help achieve the overall desired goal--an increase in minority donation rates.

Black or African American↗
PubMedDate not supplied

An innovative path to improving cancer care in Indian country.

The Native American Cancer Survivors' Support Network is an innovative public health program designed to improve survival from cancer and the quality of life after a cancer diagnosis for American Indians, Alaska Natives, and Canadian Aboriginal patients and their loved ones. The Network, initiated in 1999, now has more than 300 survivors enrolled as members. This article briefly describes the process that led to its formation and preliminary findings, primarily for breast cancer survivors, of ongoing qualitative and quantitative research. Network data show patterns of cancer care that are partially responsible for poor survivorship outcomes.

Adaptation, Psychological↗