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PubMedDate not supplied

Antithrombotic therapy for stroke prevention among Medicare beneficiaries hospitalized in Alaska with atrial fibrillation.

Although warfarin therapy reduces the risk of stroke among patients with atrial fibrillation (AF), the risk of hemorrhagic complications and other concerns may make clinicians reluctant to prescribe this treatment for elderly patients. Aspirin is a lower-risk alternative to warfarin but is also less effective. This study examines the use of antithrombotic therapy with warfarin or aspirin at hospital discharge among 182 Medicare beneficiaries 65 or older with chronic AF who were admitted to nine Alaska hospitals during 1996. Sixty-five percent of patients without contraindications were discharged on warfarin, and an additional 16% received aspirin. The rate of anticoagulation with warfarin was much higher among patients aged 65-74 (95%) than among those 75 or older (45%). The relatively low rate of warfarin use for very elderly patients may represent an opportunity to improve care. Although these patients have the highest risk of hemorrhagic complications, they also have the greatest potential to benefit from anticoagulation.

Age Distribution↗
PubMed1999

Trace metals in ancient hair from the Karluk Archaeological Site, Kodiak, Alaska.

Considerable interest exists in characterizing the extent of changes in methylmercury exposures from preindustrial to modern-day times. Hair is often preserved over centuries and has been useful in determining the extent of dietary trace metal exposures, particularly methylmercury. We examined 16 human hair samples taken from human hair bundles buried in the soil of the Karluk One Archaeological site located near the current Karluk village on the Kodiak Archipelago of Alaska. Hair samples were analyzed for total mercury, methylmercury, selenium, and cadmium. The mean total mercury level was 1.33 ppm (SD = 1.09). The mean methylmercury level, however, was considerably lower than the total mercury concentration: the mean methylmercury level was 0.03 ppm (SD = 0.02). The mean cadmium level was 0.15 ppm (SD = 0.14) and the mean selenium level was 5.22 ppm (SD = 5.73). While the concentration of total mercury in the Karluk hair samples is comparable to those observed in ancient hair from other locations, direct methylmercury quantization demonstrated that methylmercury levels were less than 2% of the total mercury in these hair samples. Because the hair was subjected to a variety of environmental influences over the centuries, the possibility of degradation of methylmercury in the hair over the last 400 to 800 years cannot be ruled out. The use of hair from remains found in more protected frozen or dry environments may provide the best evidence for the extent of preindustrial exposures to methylmercury and other trace metals.

Alaska↗
PubMed1999

First paleoparasitological analysis of a midden in the Aleutian Islands (Alaska): results and limits.

Excavations on Buldir Island, Aleutian Islands, Alaska, have revealed the remains of several features dated between the 13th and 17th centuries A.D. Soil from an open-air workshop, represented by 2 excavated pits, and a structure built of whale bones were sampled for evidence of parasites and microfloristic remains. Two groups of helminth eggs (Diphyllobothrium and Ankylostomidae) were identified in samples from the open-air pits; microfloristical remains were found in all samples. This is the first paleoparasitological analysis conducted on an Aleutian midden.

Alaska↗
PubMed1999

Outbreak of influenza A infection among travelers--Alaska and the Yukon Territory, May-June 1999.

On June 18, 1999, CDC and Health Canada received reports from public health authorities in Alaska and the Yukon Territory about clusters of febrile respiratory illness and associated pneumonia among travelers and tourism workers. This report presents information about the outbreak. Laboratory evidence, including rapid influenza A antigen-detection tests and viral cultures from respiratory specimens, has implicated influenza A virus as the cause of illness.

Alaska↗
PubMedDate not supplied

Bacterial pathogens in chronic otitis media with effusion in Alaska Native children.

This study examined the bacterial pathogens and the presence of possible risk factors for the development of chronic otitis media with effusion (OME) in a group of Alaska Native children. Middle ear aspirates were collected from 128 children < 6 years of age requiring tympanocentesis between 1987 and 1989. Bacterial pathogens were cultured from 40% of 209 fluids. Predominant isolates, after contamination of the outer ear was controlled for, were Haemophilus influenzae (21%; 84% of these were nontypeable), Streptococcus pneumoniae (8.1%; serotypes 6B, 10A, 11A, 14, 18B, 18C, 19A, and 23F), Staphylococcus epidermidis (3.8%), and Moraxella (Brahmanella) catarrhalis (2.9%). Pneumococcal-C-polysaccharide (PnC) was detectable in 3 of 135 (2.2%) aspirates that did not grow Streptococcus pneumoniae. Combining culture and PnC assay results evidence of pneumococcal infection was found in almost 10% of aspirates tested. There was not a significant difference in the number of episodes of acute otitis media after the first year of life based on the age at the first episode (< 6 mo, > or = 6 mo). However, 88% of infants in the study had their first acute otitis media episode before 1 year of age.

Alaska↗
PubMedDate not supplied

The challenge of ongoing Haemophilus influenzae type B carriage and transmission in Alaska.

Cases of invasive Haemophilus influenzae type b disease in Alaskan children quickly dropped 10-fold after widespread vaccination with a conjugate vaccine (PRP-OMP) began in 1991. However, reemergence of invasive disease in 1996-97 soon followed a change to a combination diphtheria-tetanus toxoid-pertussis/H. influenzae type b vaccine which incorporates a different conjugate vaccine (HbOC). Previously unrecognized persistence of H. influenzae type b carriage in rural Alaska, coupled with characteristics of the immune response to HbOC, are the likely explanations for disease reemergence. The current vaccine recommendation--PRP-OMP for the first dose, followed by HbOC to complete the vaccination series--appears to protect Alaskan infants even in the face of continuing carriage and transmission. Successful control of invasive H. influenzae type b disease in Alaskan children will require not only appropriate immunization, but also continuing surveillance for both disease and carriage, identification of factors associated with carriage, and investigation into the feasibility of using vaccination plus antimicrobial drugs to eliminate this pathogen.

Alaska↗
PubMed1999

American Indian and Alaska Native health behavior: findings from the behavioral risk factor surveillance system, 1992-1995.

OBJECTIVE: The purpose of this study was to evaluate differences between American Indian and white adults in behavioral risk factors for chronic disease and injury. METHODS: Data were drawn from the 1992-1995 Behavioral Risk Factor Surveillance System, an ongoing telephone survey of health behaviors of adults. Prevalence estimates by sex were calculated for American Indian and white respondents in 15 states and the significance of their differences evaluated by chi-square tests. RESULTS: American Indians were found to be at significantly higher risk than whites for fair to poor general health status, medical cost difficulties, binge drinking, cigarette smoking, not always using safety belts, being diagnosed as diabetic, and obesity. CONCLUSIONS: To reduce the gap in behavioral risk factors between American Indians and whites, more resources need to be dedicated to American Indian health. Note. The term "American Indian" henceforth refers to those who identify themselves as American Indian or Alaska Native.

Adolescent↗
PubMed2000

Outbreaks of Norwalk-like viral gastroenteritis--Alaska and Wisconsin, 1999.

Norwalk-like viruses (NLVs) are the most common cause of epidemic gastroenteritis in the United States, resulting in illness in approximately 23 million persons each year . Persons of all ages are affected because previous infection confers only short-term immunity. Most NLV gastroenteritis outbreaks involve foodborne or person-to-person transmission. This report presents investigations of a foodborne NLV outbreak in Alaska and person-to-person transmission in Wisconsin.

Alaska↗
PubMed2000

The Ahalaya case-management program for HIV-infected American Indians, Alaska Natives, and Native Hawaiians: quantitative and qualitative evaluation of impacts.

The Ahalaya case management model was designed to provide culturally sensitive services to HIV-positive American Indians (AI), Alaska Natives (AN), and Native Hawaiians (NH). This program started in 1991 and expanded across the country in 1994. The evaluation plan included a client satisfaction survey, along with focus groups and key informant interviews. Of the 389 active clients enrolled, 132 responded to the anonymous 35-item questionnaire. Responses were favorable regarding benefits of the programs. Self-reported quality of life changes after enrollment also were significantly improved (Wilcoxon Signed Rank Test: T=6.87, p=.000; n=131). Qualitative data highlighted other important issues. Social relationships-with staff, community, and family-were critical to client welfare, as a source of both strength and fear. While AI/AN/NH case management programs have been shown effective, services need to expand, and they have to facilitate resolutions to problems in clients social relationships.

Adult↗
PubMedDate not supplied

[Yeast biodiversity in hydromorphic soils with reference to grass-Sphagnum swamp in Western Siberia and the hammocky tundra region( Barrow, Alaska)].

The microbiological analysis of 78 samples taken from a boreal bog in Western Siberia and from a tundra wetland soil in Alaska showed the presence of 23 yeast species belonging to the genera Bullera, Candida, Cryptococcus, Debaryomyces, Hanseniaspora, Metschnikowia, Mrakia, Pichia, Rhodotorula, Saccharomyces, Sporobolomyces, Torulaspora, and Trichosporon. Peat samples from the boreal bog were dominated by eurytopic anamorphic basidiomycetous species, such as Rhodotorula mucilaginosa and Sporobolomyces roseus, and by the ascomycetous yeasts Candida spp. and Debaryomyces hansenii. These samples also contained two rare ascomycetous species (Candida paludigena and Schizoblastosporion starkeyi-henricii), which so far have been found only in taiga wetland soils. The wetland Alaskan soil was dominated by one yeast species (Cryptococcus gilvescens), which is a typical inhabitant of tundra soils. Therefore, geographic factors may serve for a more reliable prediction of yeast diversity in soils than the physicochemical or ecotopic parameters of these soils.

Alaska↗
PubMed2002

Prevalence of seasonal affective disorder among U.S. Army soldiers in Alaska.

OBJECTIVES: The goal of this study was to examine the prevalence of seasonal affective disorder among 1,116 active duty men and 191 active duty women stationed at an Army installation in Alaska. METHOD: Prevalence estimates of seasonal affective disorder (SAD) were calculated in two different ways. The first was based on the "classic" criteria in which only January and February are regarded as the winter months. The second was based on the "arctic" criteria in which November and December are included as winter months. RESULTS: Prevalence estimates of classic SAD were 5.2% for men and 8.9% for women. Prevalence estimates of arctic SAD were 6.5% for men and 13.1% for women. Subjects who met arctic criteria but not classic criteria for SAD self-reported significantly more current depression than those who met classic criteria. CONCLUSION: The question of whether individuals meeting arctic criteria have a more severe form of SAD may be an area worth exploring.

Adult↗
PubMed2002

Concentrations of trace elements in eggs and blood of spectacled and common eiders on the Yukon-Kuskokwim Delta, Alaska, USA.

We examined the relations among nesting success, egg viability, and blood and egg concentrations of As, Cd, Pb, Hg, and Se in a threatened population of spectacled eiders (Somateria fischeri) and a sympatric population of common eiders (S. mollissima) on the Yukon-Kuskokwim Delta, Alaska, USA, during 1995 and 1996. During the early breeding season, males and females had mean Se concentrations in their blood of 19.2 microg/g and 12.8 microg/g wet weight, respectively. Blood Se concentrations of females were correlated with egg concentrations. During brood rearing, blood Se levels were higher in adult females than in ducklings. Blood concentrations of Pb in spectacled eider females were higher than in common eider females captured at hatching, but blood concentrations of Se were similar. Trace element concentrations were not related to nest success or egg viability. We submit that nest success and egg viability of spectacled eiders are not related to concentrations of the trace elements we measured. Because blood Se concentrations declined rapidly through the breeding season and were not related to nest success or egg viability, we suggest that spectacled eiders are exposed to high concentrations of Se during winter that pose little threat to this population.

Alaska↗
PubMed2002

Intimate partner violence among U.S. Army soldiers in Alaska: a comparison of reported rates and survey results.

OBJECTIVES: A U.S. Army post in Alaska (Fort A) was determined to have a higher than average rate of officially reported cases of spousal abuse compared with the Army as a whole. The purpose of the present study was to determine whether Fort A had a higher rate of self-reported spousal abuse compared with the Army as a whole. METHOD: A survey on intimate partner violence was conducted among 648 married male personnel who completed a questionnaire that included the Modified Conflict Tactic Scale. RESULTS: Comparisons with results of an earlier study involving a large representative sample of Army personnel indicated that Fort A did not have higher levels of intimate partner violence than the Army average based on soldiers' self-reports. CONCLUSION: It may not be appropriate to draw conclusions about serious intimate partner violence in the military based solely on the results of family conflict surveys.

Adult↗
PubMed2002

Substance use among American Indians and Alaska natives: incorporating culture in an "indigenist" stress-coping paradigm.

OBJECTIVES: This article proposes a new stress-coping model for American Indians and Alaska Natives (AIs) that reflects a paradigmatic shift in the conceptualization of Native health. It reviews sociodemographic information on AIs, rates of substance abuse and related health outcomes, and the research supporting the model's pathways. OBSERVATIONS: Although health outcomes among AIs are improving, large disparities with other racial and ethnic groups in the United States remain. Many health-related problems are directly linked to high rates of substance use and abuse. CONCLUSION: Eurocentric paradigms focus on individual pathology. An "indigenist" perspective of health incorporates the devastating impact of historical trauma and ongoing oppression of AIs. The model emphasizes cultural strengths, such as the family and community, spirituality and traditional healing practices, and group identity attitudes.

Adaptation, Psychological↗
PubMedDate not supplied

Alaska outreach.

Bringing dental hygiene and dental education to a remote section of far northern Alaska provides both challenges and rewards.

Alaska↗
PubMedDate not supplied

Anal cancer in Alaska; a retrospective study of incidence, treatment, and outcomes.

Anal cancer is a rare tumor usually of squamous histology that is managed most often with concurrent chemotherapy and radiation therapy. Surgery is commonly reserved for those who fail primary treatment. We conducted a retrospective analysis of the medical records of patients with anal cancer seen in two radiation therapy centers in Alaska from the period of 1996 to mid-2001. Records were reviewed for diagnosis, sex, age, staging, treatment and outcomes. Twenty-four patients were identified with squamous cell carcinoma of the anus. Average age at diagnosis was 53. Tumor size was predominantly 2-5 centimeters. Four patients had nodal involvement and three had distant metastasis. Twenty patients received radiation. Nineteen received flourouracil and either cisplatin or mitomycin. Three patients underwent abdominoperineal resections. Ten were found to have no evidence of disease at an average of twenty-two months. These results are consistent with findings of larger studies elsewhere.

Alaska↗
PubMedDate not supplied

Increasing survival of extremely low birthweight infants in Alaska.

The survival and characteristics of extremely premature infants with a birthweight between 500 and 750 grams, who were treated at Providence Hospital newborn intensive care unit, were reviewed over the years 1987 to 1989. Forty infants were admitted and treated. Survival increased from 21 percent in 1987, 47 percent in 1988 to 82 percent in 1989. Changes in perinatal and neonatal factors over the three years were reviewed and comparisons between survivors and non-survivors were analyzed. Stepwise regression analysis revealed significant increases in the incidence of chorioamnionitis and birthweight over the period. Increased survival was noted even when infants from 1989, who received artificial surfactant, were excluded (survival increased from 21 percent in 1987 to 75 percent in 1989). Recent literature on extremely low birthweight infants, including neurodevelopmental outcome, is reviewed. Survival of extremely low birthweight infants in Alaska is increasing because of multiple changes in obstetrical and pediatric practices.

Alaska↗
PubMed2003

Injury mortality among American Indian and Alaska Native children and youth--United States, 1989-1998.

Injuries account for 75% of all deaths among American Indian and Alaska Native (AI/AN) children and youth, and AI/ANs have an overall injury-related death rate that is twice the U.S. rate for all racial/ethnic populations. However, rate disparities vary by area and by cause. To help focus prevention efforts, CDC analyzed injury mortality data by Indian Health Service (IHS) administrative area and by race/ethnicity. This report summarizes the results of these analyses, which indicate that although death rates for some causes (e.g. drowning and fire) have shown substantial improvement over time, rates for other causes have increased or remained unchanged (e.g., homicide and suicide, respectively). Prevention strategies should focus on the leading causes of injury-related death in each AI/AN community, such as motor-vehicle crashes, suicides, and violence.

Accidents, Traffic↗