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At least 631 records · Page 35Linked to original sources
PubMed1999

Injury hospitalizations among American Indian youth in Washington.

OBJECTIVE: To determine the rate and causes of hospitalizations for injury among American Indian and Alaska Native (AI/AN) youth in the state of Washington, and to compare this with the rate of hospitalizations for injury among youth of all races. METHODS: Subjects were aged 0-19 years and were admitted to civilian hospitals for care of an injury (International Classification of Diseases N codes 800-995) in Washington between 1990 and 1994. Deaths occurring in the prehospital setting and emergency department are not included. Using several fields of identifying information, the Washington state hospital discharge database was linked with the Indian Health Service (IHS) patient registration database to identify AI/AN youth. Denominator data included the total age specific IHS user population for American Indians and US Census derived population estimates. Incidence ratios (IRs) were calculated to compare rates of hospitalization between AI/AN youth and all youth in Washington. RESULTS: A total of 694 and 29,048 hospitalizations for injury were identified for AI/AN youth and all races, respectively. The rate of hospitalization for injuries among AI/AN youth was 507 discharges per 100,000 youth (IR = 1.30; 95% confidence interval (CI) 1.20 to 1.40. The leading mechanism of injury was motor vehicles (IR 1.73, CI 1.49 to 2.01), followed by falls (IR 0.95, CI 0.79 to 1.15), and poisoning (IR 1.20, CI 0.80 to 1.78). The disparity was greater for intentional injuries (IR 1.71, CI 1.44 to 2.04). The highest IR for all unintentional injuries was for injuries from fire (IR 2.35, CI 1.42 to 3.87). AI/AN children aged 15-19 had the greatest disparity for rates of injury hospitalization (IR 1.4, CI 1.25 to 1.56). CONCLUSION: AI/AN youth in Washington had a higher hospitalization rate for injury compared with all youth in the state. Disparities were greatest for injuries related to motor vehicles and assaults. When linked, hospital discharge data can be used for surveillance of AI/AN hospitalizations.

Adolescent↗
PubMed2005

A developmental model for rural telepsychiatry.

Telepsychiatry represents a promising means to increase access to care for rural American Indian communities. This article describes rural telepsychiatry clinics operated by the American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center through a partnership with the Department of Veterans Affairs, the Indian Health Service, and local tribal health services that target American Indian veterans with posttraumatic stress disorder. A six-stage model for developing such services is presented. The model consists of needs identification, infrastructure survey, partnership organization, structure configuration, pilot implementation, and solidification. This article traces program development, presents challenges in implementing these services, and offers potential solutions. The model can guide the development of telepsychiatry services for American Indians specifically and rural populations in general.

Health Services Accessibility↗
PubMedDate not supplied

Invasive cervical cancer among American Indian women in the Northern Plains, 1994-1998: incidence, mortality, and missed opportunities.

OBJECTIVES: Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region. METHODS: We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population. RESULTS: Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100,000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms. CONCLUSIONS: While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.

Adult↗
PubMedDate not supplied

Designing and evaluating diabetes education material for American Indians.

This paper describes the methods used to develop and evaluate diabetes education material for American Indians and Alaska Natives living in Washington, Oregon, and Idaho. Reading skills of individuals and readability of a sample of existing diabetic education material were measured. Using the Wide Range Achievement Test to measure reading skills, the authors found that 66% of the sample read at a 5th "grade" or higher level. Readability of a sample of available diabetic education material was found to be, on average, at the 10th "grade" level. Diabetes education booklets targeted to a 5th to 7th "grade" level were developed and assessed for acceptability and comprehension. Final evaluation, using the close procedure, showed that 62% of the target audience understood the messages in the booklets. A comprehensive assessment process was found to be useful in developing effective diabetes education material for Indian communities.

Cultural Characteristics↗
PubMed2004

Access, relevance, and control in the research process: lessons from Indian country.

OBJECTIVE: To illustrate successful strategies in working with American Indian (AI) and Alaska Native (AN) communities in aging and health research by emphasizing access, local relevance, and decision-making processes. METHODS: Case examples of health studies involving older AIs (greater than or equal to 50 years) among Eastern Band Cherokee Indians, a federally recognized reservation; the Cherokee Nation, a rural, nonreservation, tribal jurisdictional service area; and Lakota tribal members living in Rapid City, South Dakota. RESULTS: Local review and decision making reflect the unique legal and historical factors underpinning AI sovereignty. Although specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders. CONCLUSIONS: Most investigators are unprepared to address the demands of health research in AI communities. Community-based participatory research in this setting conflicts with investigators' desire for academic freedom and scientific independence. Successful collaboration promises to enhance research efficiencies and move findings more quickly to clinical practice.

Aged↗
PubMed2005

The promise and the challenge of the spirit of E.A.G.L.E.S. program.

BACKGROUND: The Spirit of E.A.G.L.E.S. is a National Cancer Institute funded Special Populations Network. Prior to its inception, there was limited infrastructure available to American Indian and Alaska Native populations to support cancer control activities. METHODS: Awareness has been raised about the burden of cancer in this special population. RESULTS AND CONCLUSIONS: Changes have started to support truly comprehensive cancer control across the cancer care continuum and will drive future community-based, participatory action research.

Community Participation↗
PubMed1981

Use of the Williams microclip in various aspects of tymanoplastic surgery.

The microclip was invented by J. David Williams, M.D. in 1971 in an attempt to devise a technique to reliably secure a medially placed fascia graft to a tympanic membrane remnant. This method immediately improved the graft take rate to better than 90% in the Alaska native population with whom he was working. Included in this 90% and above category were many ears that demonstrated some degree of mucosal edema, granulation tissue, or mucopurulent discharge--referred to in this paper as the "wet ear." Anatomic and audiologic results of 286 consecutive otologic procedures requiring a tympanic membrane graft will be presented in which the Williams microclip has been employed to secure a medially placed graft. Attention well be devoted to both success and failure of the methods employed. Special attention will be given to the description of surgically challenging situations in tympanoplasty surgery such as "the narrow to non-existent remnent segment" where the microclip demonstrates its exceptional usefulness. Last, additional uses of the microclip (other than in tympanic membrane grafting) will be discussed including its application in a new technique of ossicular chain reconstruction. Case reports and statistical data will augment material presented.

Adolescent↗
PubMed2004

Reducing unintentional injuries on the nation's highways: a literature review.

Death and injury on the nation's highways is a public health crisis, especially for youth and members of selected minority groups. The objective of this paper is to review the literature on behavioral and environmental factors that increase risk for traffic morbidity and mortality in populations at high risk. Each of the following is a risky traffic-related behavior: not wearing seat belts, not using child safety seats, not wearing bicycle or motorcycle helmets, driving after drinking, driving while fatigued or distracted, speeding, running red lights, and aggressive driving. Environmental factors that modify risk include urban sprawl, highway design, public policy, racism and economic inequality. High risk groups include youths, males, pickup truck drivers, urban dwellers, the elderly, African Americans, American Indians, and Alaska Natives. A comprehensive approach must be developed for reducing traffic-related risk of death and injury, especially in high risk populations.

Accident Prevention↗
PubMed1993

Access to care in the Indian Health Service.

The Indian Health Service (IHS) is unique among U.S. private and public health programs in that free comprehensive health services are provided to eligible American Indians and Alaska Natives regardless of their ability to pay. However, resource limitations may compel some eligible persons to go outside of the IHS system to receive health care. Although IHS eligibles have comparatively low rates of private or public health care coverage, and much of this population lives in underserved areas, over half of IHS-eligible persons had some type of out-of-plan use in 1987. Furthermore, services received through private providers appear to supplement those received through IHS-sponsored providers. Overall, persons who use both IHS and non-IHS providers have higher levels of health care use than do those who rely exclusively on the IHS.

Adolescent↗
PubMed2004

HIV/AIDS prevention in "Indian country": current practice, indigenist etiology models, and postcolonial approaches to change.

Many tribal and urban American Indians and Alaska Native communities have initiated HIV/AIDS prevention and treatment services. The richness, depth, and scope of these efforts, however, are not well known and have not been sufficiently documented in the academic literature. In this article we assess the strengths and weakness of the published literature using the constructs of the socioecological framework. We discuss the need to apply an "indigenist" etiology paradigm to HIV/AIDS risk and protection. Finally, we define and discuss the varied postcolonial approaches to HIV/AIDS prevention, treatment, and healing.

Adaptation, Psychological↗
PubMed2006

Bridging disparity: a multidisciplinary approach for influenza vaccination in an American Indian community.

OBJECTIVES: The Whiteriver Service Unit (WRSU) used proven effective methods to conduct an influenza vaccination campaign during the 2002-2003 influenza season to bridge the vaccination gap between American Indians and Alaska Natives and the US population as a whole. METHODS: In our vaccination program, we used a multidisciplinary approach that included staff and community education, standing orders, vaccination of hospitalized patients, and employee, outpatient, community, and home vaccinations without financial barriers. RESULTS: WRSU influenza vaccination coverage rates among persons aged 65 years and older, those aged 50 to 64 years, and those with diabetes were 71.8%, 49.6%, and 70.2%, respectively, during the 2002-2003 influenza season. We administered most vaccinations to persons aged 65 years and older through the outpatient clinics (63.6%) and public health nurses (30.0%). The WRSU employee influenza vaccination rate was 72.8%. CONCLUSIONS: We achieved influenza vaccination rates in targeted groups of an American Indian population that are comparable to or higher than rates in other US populations. Our system may be a useful model for other facilities attempting to bridge disparity for influenza vaccination.

Aged↗
PubMed2005

Cancer screening and risk factor rates among American Indians.

OBJECTIVES: We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. METHODS: We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. RESULTS: Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. CONCLUSIONS: Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

California↗
PubMed2005

Diabetes outcomes in the Indian health system during the era of the Special Diabetes Program for Indians and the Government Performance and Results Act.

OBJECTIVES: We reviewed changes in blood glucose, blood pressure, and cholesterol levels among American Indians and Alaska Natives between 1995 and 2001 to estimate the quality of diabetes care in the Indian Health Service (IHS) health care delivery system. METHODS: We conducted a cross-sectional analysis of data from the Indian Health Service Diabetes Care and Outcomes Audit. RESULTS: Adjusted mean Hemoglobin A1c (HbA1c) levels (7.9% vs 8.9%) and mean diastolic blood pressure levels (76 vs 79 mm Hg) were lower in 2001 than in 1995, respectively. A similar pattern was observed for mean total cholesterol (193 vs 208 mg/dL) and triglyceride (235 vs 257 mg/dL) levels in 2001 and 1995, respectively. CONCLUSIONS: We identified changes in intermediate clinical outcomes over the period from 1995 to 2001 that may reflect the global impact of increased resource allocation and improvements in processes on the quality of diabetes care, and we describe the results that may be achieved when community, health program, and congressional initiatives focus on common goals.

Cross-Sectional Studies↗
PubMed2006

Building true capacity: indigenous models for indigenous communities.

Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners. Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.

Community Participation↗
PubMed2003

Qualitative study of the use of traditional healing by asthmatic Navajo families.

Despite increasing prevalence of asthma among American Indians and/or Alaska Natives, little is known about their use of traditional healing in its management. A convenience sample of 24 Navajo families with asthmatic members (n=35) was interviewed between June 1997 and September 1998. While 46% of families had previously used traditional healing, only 29% sought traditional healing for asthma. Use of traditional healing was unrelated to use of biomedical therapies, hospitalizations, or emergency services. Practical factors and questions about the nature and origins of asthma were the primary considerations determining use of traditional medicine. Little conflict between traditional healing and biomedical treatment was reported. The use of traditional healing for asthma is influenced by beliefs about the disease and factors specific to the individual, including their local social, economic, and cultural context.

Adolescent↗
PubMed1993

Special issues regarding obesity in minority populations.

Special attention must be given to obesity as it occurs in and affects ethnic minorities (that is, black Americans, Hispanic Americans, Asian and Pacific Islander Americans, American Indians and Alaska Natives, and Native Hawaiians) in the United States. In most of these groups, the prevalence of obesity is substantially higher than in whites, especially among women. Poverty and lower educational attainment, which are associated with higher than average rates of female obesity (independent of ethnicity), affect proportionately more persons in these minority populations than in white populations. Diabetes mellitus and certain other obesity-related conditions occur to a markedly greater than average extent in many minority populations. A high-risk body fat distribution (upper body or central obesity) occurs to a greater extent in some minority populations than in whites. Because of situational and cultural factors, effective obesity prevention and treatment approaches may need to be defined on an ethnicity-specific basis. Increased attention to obesity as it occurs in and affects diverse ethnic groups can help to address critical minority health issues. Such efforts can also broaden and enrich aspects of obesity research for which models based on white populations are inappropriate or limited.

Body Constitution↗
PubMed2004

Primary prevention of type 2 diabetes mellitus by lifestyle intervention: implications for health policy.

More than 18 million Americans currently have diabetes mellitus. The economic and human cost of the disease is devastating. In the United States, diabetes is the most common cause of blindness among working-age adults, the most common cause of nontraumatic amputations and end-stage renal disease, and the sixth most common cause of death. For the cohort of Americans born in 2000, the estimated lifetime risk for diabetes is more than 1 in 3. In the next 50 years, the number of diagnosed cases of diabetes is predicted to increase by 165% in the United States, with the largest relative increases seen among African Americans, American Indians, Alaska Natives, Asian and Pacific Islanders, and Hispanic/Latino persons. Compelling scientific evidence indicates that lifestyle change prevents or delays the occurrence of type 2 diabetes in high-risk groups. This body of evidence from randomized, controlled trials conducted in 3 countries has definitively established that maintenance of modest weight loss through diet and physical activity reduces the incidence of type 2 diabetes in high-risk persons by about 40% to 60% over 3 to 4 years. The number of persons at high risk for type 2 diabetes is similar to the number of persons who have diabetes. This paper summarizes scientific evidence supporting lifestyle intervention to prevent type 2 diabetes and discusses major policy challenges to broad implementation of lifestyle intervention in the health system.

Behavior Therapy↗