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PubMed1992

Diabetes mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 yr.

OBJECTIVE: To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. RESEARCH DESIGN AND METHODS: Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of greater than or equal to 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents greater than or equal to 40 yr of age in 15 villages in southwestern Alaska. RESULTS: Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. CONCLUSIONS: The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Alaska↗
PubMed2005

Cancer education for Community Health Aides/Practitioners (CHA/Ps) in Alaska assessing comfort with cancer.

BACKGROUND: Village-based Community Health Aides and Community Health Practitioners (CHA/Ps) are the primary providers of health care in rural Alaska. METHODS: We discuss the development and results of a CHA/P cancer self-assessment survey, which assessed comfort with cancer knowledge and providing cancer information. RESULTS: A total of 402 responses were received from a mailed questionnaire to 477 CHA/Ps. Respondents were predominantly Alaska Native women. Using a 5-point Likert scale from don't know to very comfortable, approximately 50% of CHA/Ps reported feeling "OK" when providing information about cancer risk factors, cancer screening, surviving cancer, and providing care and support. CHA/Ps reported feeling less comfortable with discussing cancer diagnosis, treatment, pain, and loss and grief.

Adult↗
PubMed1997

Temporal trends and geographic patterns of teen suicide in Alaska, 1979-1993.

The author analyzed death certificate and U.S. census data to document trends in suicide rates among Alaskans 14-19 years of age. During 1979-1993, Alaskan teenagers had a suicide rate of 31.5 per 100,000 persons per year. Suicide rates varied up to sixfold by race, gender, and local census area of residence; in particular, Alaska Native males had one of the highest documented suicide rates in the world. Suicide rates increased two- to threefold during the study period for persons less than 18 years of age, while remaining stable for older teenagers. Within census areas, suicide rates correlated inversely with the percentage of all households headed by a married couple.

Adolescent↗
PubMed1998

Cocaine smokers and injection drug users in Alaska: what distinguishes Native Americans from non-Native Americans?

Demographic and behavioral characteristics were modeled for distinguishing Native American drug users from non-Native American drug users in Anchorage, Alaska. Data were collected using a structured interview administered to participants (n = 1,091) who smoked cocaine, injected drugs, or both. Multivariate analyses were performed using logistic regression modeling. Four characteristics distinguish Native Americans (n = 223) from non-Native Americans (n = 868). Native Americans were more likely to have used marijuana at an earlier age and to have less than high school education; they were less likely to have ever used heroin and cocaine together, and to have used a condom during sex. Results are useful for administering interventions, data collection, and targeting hidden populations.

Adolescent↗
PubMed1998

Cultural concerns regarding contaminants in Alaskan local foods.

Indigenous people of Alaska, who depend in many ways on foods which they obtain locally by hunting, fishing, and gathering, have raised concerns about the changing quality of their foods in light of confirmation of the long-range transport of global pollutants. A review of a variety of parallel research efforts has shown little consistency in practice, no clear evaluation of exposure levels through dietary surveys on a broad scale, and no comprehensive educational effort to inform the general public of the changing levels of pollutants in local foods. Nor has there been adequate communication regarding the source of the contamination, whether natural contaminants or anthropogenic pollution. Alaska Native cultural issues that contribute to the risk perception of a health problem inherent in eating a traditional diet that is showing signs of increasing levels of pollution, no matter how small, must be considered in any recommendations regarding locally obtained foods and in public health efforts. Recommended cross-cultural communication methods should be employed in dealing with topics of high community concern.

Alaska↗
PubMed1993

Community patterns of psychiatric disorders after the Exxon Valdez oil spill.

OBJECTIVE: This study examined the relationship between exposure to the Exxon Valdez oil spill and subsequent cleanup efforts and the prevalence of generalized anxiety disorder, posttraumatic stress disorder (PTSD), and depressive symptoms in 13 Alaska communities. METHOD: A community survey of 599 men and women was conducted approximately 1 year after the spill occurred. Questions from the National Institute of Mental Health Diagnostic Interview Schedule were used to assess symptoms of generalized anxiety disorder and PTSD. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to assess levels of depressive symptoms. RESULTS: The post-spill (i.e., 1-year) prevalence of generalized anxiety disorder and PTSD for the study communities with all degrees of exposure was 20.2% and 9.4%, respectively. The prevalence of respondents with CES-D Scale scores above 16 and 18 was 16.6% and 14.2%, respectively. When compared with the unexposed group, members of the high-exposure group were 3.6 times as likely to have generalized anxiety disorder, 2.9 times as likely to have PTSD, 1.8 times as likely to have a CES-D Scale score of 16 and above, and 2.1 times as likely to have a CES-D Scale score of 18 and above. Women exposed to this event were particularly vulnerable to these conditions, and Alaska Natives were particularly vulnerable to depressive symptoms after the oil spill. CONCLUSIONS: The results suggest that the oil spill's impact on the psychosocial environment was as significant as its impact on the physical environment. The Exxon Valdez experience suggests a number of implications for the mental health needs of disaster victims, particularly in primary care settings.

Accidents↗
PubMed1992

An oral health survey of Head Start children in Alaska: oral health status, treatment needs, and cost of treatment.

The purpose of this study was to obtain information on the oral health status, treatment needs, and cost of treatment for Head Start children in Alaska. Twenty communities, representing five regions within the state, were selected for participation. The study consisted of three distinct parts: a caries status exam, a sociodemographic questionnaire, and a treatment needs examination. A total of 544 children between three and five years old were examined. The mean dmft and dmfs scores were 3.91 and 8.73, respectively. When stratified by race, the Alaska Native children had significantly higher mean dmft and dmfs scores. When stratified by community of residence, those children residing in the rural communities had higher rates of dental caries than the urban children. Forty-five percent of the total sample was in need of dental restorative treatment, excluding examinations, radiographs, and preventive services. The proportion of rural children needing care was much higher than the urban children (59% vs 27%). On average, each urban child needed treatment on 0.7 teeth, while each rural child needed treatment on 2.8 teeth. When all treatment factors including sedation and transportation costs are considered, the potential cost of treatment for the 1,475 children enrolled in the Alaska Head Start programs was $601,624.

Age Factors↗
PubMed1993

Diabetes in American Indians. An overview.

OBJECTIVE: To review the growth of diabetes as a major health problem for American Indians and Alaska Natives. RESEARCH DESIGN AND METHODS: Pertinent studies of diabetes in Indians previously published are reviewed and compared with current data. RESULTS: Although diabetes rates may vary among different Indian tribes, diabetes has become a widespread health problem. CONCLUSIONS: Our understanding of the natural history of diabetes among Indians has improved, but better strategies to prevent complications and ultimately to prevent diabetes are urgently needed in Indian communities.

Adolescent↗
PubMed1996

Cervical cancer screening on the Yukon-Kuskokwim Delta, Southwest Alaska. A population-based study.

BACKGROUND: Alaska Native women suffer excess morbidity and mortality due to cervical cancer. This population-based study analyzed data from a regional Pap smear registry to describe the 2-year prevalence of cervical cancer screening for the women who live in remotely located villages in the Yukon-Kuskokwim Delta region. METHODS: All women older than 18 years of age who lived in one of the villages of the Yukon-Kuskokwim Delta were included (n = 6916). A 2-year Pap prevalence rate for each village was estimated by counting the number of women who had at least one Pap smear between September 1, 1992, and August 31, 1994, using the computer-based Pap registry located at the regional medical center in Bethel, Alaska. Population estimates for each village were obtained from a database maintained by the local office of the State of Alaska's Public Health Nurses. RESULTS: The overall 2-year Pap prevalence rate for the population was 62%. By age group, 2-year prevalence rates were as follows: women 18 to 44 years, 64%; women 45 to 64 years, 58%; and women 65 years and older, 52%. CONCLUSION: This study demonstrated that there is a significant need to improve access to and use of cervical cancer screening in this region to achieve national and state objectives. Village-based clinic staff are underutilized for cancer prevention service delivery; with additional training and supervision, staff members may serve as a means to improve this preventive health care service.

Adolescent↗
PubMedDate not supplied

Comorbidity: meaning and uses in cross-cultural clinical research.

American Indians and Alaska Natives were the subject of a workshop sponsored by the National Institute of Mental Health and the Indian Health Service. Comorbidity of anxiety, depression, and substance abuse is highly prevalent in these two populations, and this was the focus of the meeting. This paper introduces the topic of psychiatric comorbidity, and considers the topics of culture, psychiatric diagnosis, and assessment. Future research directions and a brief summary of the papers presented at the workshop, which are included in this issue, are provided.

Alaska↗
PubMed1990

Halbwachs and Durkheim: a test of two theories of suicide.

The social integration hypothesis forms the basis of this study. It was first asserted by Durkheim in late nineteenth-century France and many of his assumptions are based on a social disorganizational model. This model tended to equate social change with the breakdown of social control and many of Durkheim's notions about anomie are derived from this view of industrial society. Halbwachs, on the other hand, proposed a social psychological theory of suicide. His model specifies more clearly the conditions under which lack of social integration may induce suicide. This study shows that among a population in transition, the Alaska Natives, the suicide rate was explained by the Halbwachsian model at least as well as the Durkheimian one and sometimes better. The Durkheimian model is shown to reflect a Cartesian dualism, which accounts only for that which is observable, thus making for biased studies of suicide. Moreover, psychopathological research confirms the Halbwachsian model. These findings restore the social isolation theory, once long neglected, to its rightful place among theories of suicide and opens up an important field for researchers seeking to understand high rates of suicide.

Alaska↗
PubMed2000

Serotype distribution and antimicrobial resistance patterns of invasive isolates of Streptococcus pneumoniae: Alaska, 1991-1998.

From January 1991 through December 1998, a total of 1046 pneumococcal isolates were received from 23 laboratories participating in the statewide surveillance system. Of these, 1037 were recovered from normally sterile sites (blood and cerebrospinal and pleural fluid) and were available for serotyping and susceptibility testing. Ninety-two percent of these isolates were serotypes represented in the 23-valent pneumococcal polysaccharide vaccine. Serotypes in the 7-valent pneumococcal conjugate vaccine (4, 6B, 9V, 14, 18C, 19F, and 23F) were recovered from 72% of Alaska Natives and 84% of non-Native children <5 years old with invasive disease. Statewide, 7.3% and 3.2% of isolates had intermediate and high levels of resistance to penicillin, respectively; 9.2% were resistant to erythromycin (minimal inhibitory concentration, >/=1 microg/mL) and 19% to trimethoprim/sulfamethoxazole (minimal inhibitory concentration, >/=4/76 microg/mL). Twelve percent of invasive isolates were resistant to >/=2 classes of antibiotics; of these, serotype 6B accounted for 33%, and 63% were recovered from children <5 years old.

Alaska↗
PubMedDate not supplied

Provision of health care in a frontier setting: an Alaskan perspective.

The Community Health Aide Program is the Indian Health Service's answer to to the provision of care to 45,000 Alaska Native people living in remote areas of the state. Community health aides are local people who live and work in their villages. They offer health services from emergency to preventative care with the help of their referral physician, who may be up to 1,300 miles away. Nurse practitioners play an important role in the training and supervision of community health aides. This article gives an overview of the program, its successes and problems, with implications as a health care delivery model for care in other underserved areas of the United States.

Alaska↗
PubMedDate not supplied

Training injury control practitioners: the Indian Health Service model.

Many individuals practicing injury control have not received specific training for their work, in large part because of a scarcity of training opportunities. Consistent with its mission of "raising the health status of American Indian and Alaska Native people to the highest possible level," the Indian Health Service (IHS) created an innovative training program for federal and tribal employees. The model emphasizes training that is practical and can be applied immediately to community interventions. Many features of the IHS training model have broad applicability to other settings. These features include the use of experiential instruction, preceptors, and community case studies to train individuals from diverse cultural and educational backgrounds; educational strategies for employed adults; and courses that promote community empowerment. The development of IHS training courses are guided by community input, epidemiological data, advances in knowledge, and program evaluations. Courses range from a half-day "minicourse" to a full-year fellowship program. The success of the training model is evident in programs instituted by IHS Injury Prevention Specialist Fellowship graduates, whose projects have ranged from drowning prevention in Alaska to fire safety in North Dakota. The IHS training model could be applied in a variety of other community-based settings, but it is most relevant to programs that train individuals from diverse backgrounds who are not full-time students and programs that make community needs an organizational priority.

Accident Prevention↗
PubMed1999

One year in an Alaskan arthritis clinic.

During 1997 visits were made by 852 individuals to an arthritis clinic in Alaska serving predominantly Alaska Natives. Three hundred twenty- seven of these were seen for the first time. The ratio of women to men was 3:1. Rheumatoid Arthritis was the most common arthritic condition seen, followed by Degenerative Joint Disease and Spondyloarthropathies. Three hundred five Tlingit and 246 Eskimo made up 65% of the patients seen that year. Methotrexate was the most frequently used Disease Modifying Antirheumatic Drug but the other such drugs were prescribed as well. Recording demographic and clinical information on a portable computer at the time of visit provided record linkage and the data for this report and was used in Health Care Planning.

Alaska↗
PubMed2005

Using theater to promote cancer education in Alaska.

BACKGROUND: Cancer, a rare disease in the 1950s, is now the leading cause of death among Alaska Natives (AN). METHODS: Building on AN rich traditions of storytelling to share knowledge and wisdom, a 45 minute play, Understanding, was developed to address cancer-related issues specific to AN. RESULTS: Written audience evaluations assessed the impact of this theater-based education. After seeing the play, 327 (94.5%) people reported feeling more comfortable talking about cancer, 265 (66.1%) shared that they had learned about cancer, and 234 (61.7%) wrote healthy ways they intended to change their behavior. CONCLUSION: A postplay discussion provided an opportunity for the audience to share their stories, concerns, beliefs, and feelings.

Adolescent↗
PubMed2006

Healing hearts: laughter and learning.

BACKGROUND: Cultural values of Alaska Native people acknowledge laughter as good medicine. It is heard in their words and stories. METHODS: To investigate how and in what ways laughter impacts learning from the learners' perspective, cancer education course evaluations were reviewed and a survey administered. RESULTS: 94% (235/259) of Community Health Aides and Community Health Practitioners surveyed emphasized the importance of laughter to support adult learning. Written comments are grouped into three main themes: (1) supporting a comfortable learning community, (2) relieving stress, and (3) enhancing learning. DISCUSSION: This study demonstrates the value and significance of laughter to support people in their learning journey.

Alaska↗
PubMed1996

Hypertension and diabetes among Siberian Yupik Eskimos of St. Lawrence Island, Alaska.

CHANGING DIETS AND LIFESTYLES contribute to an increase in the prevalence of cardiovascular disease and diabetes in Alaska Natives. To examine the problem in detail, we have begun a systematic screening of various ethnic groups by carrying out a pilot study of Siberian Yupik Eskimos ages 39 and over. Mean LDL and HDL levels were 157 mg/dl and 63 mg/dl. Mean fasting insulin was 7.0 microunits/ml; and mean BMI, 27.1. Fasting insulin level was significantly related to both diastolic blood pressure and fasting triglyceride levels, but not to systolic blood pressure, total cholesterol, LDL cholesterol, or HDL cholesterol levels. Of the 66 people screened, 27% had evidence of hypertension.

Adult↗