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PubMed1992

Hepatitis A outbreak in Anchorage, Alaska, traced to ice slush beverages.

The Alaska Department of Health and Social Services investigated a community outbreak of hepatitis A in Anchorage. A total of 57 persons who had hepatitis A between June and September 1988 were studied. Patients ranged from 1 to 54 years of age. A market was implicated as the source of the outbreak. An employee who prepared beverage mixtures in a bathroom was a contact of a person who had had hepatitis A 2 months before the outbreak; the employee was reported to have been jaundiced 3 to 4 weeks before the peak of the outbreak. The administration of immune globulin had an efficacy of 100% (95% confidence limits 69, 100%) in preventing hepatitis A among household contacts of primary cases. Similar beverages are sold by convenience markets and many other businesses nationwide. It is important to ensure that safe food-handling practices are followed by such establishments.

Adolescent↗
PubMed1991

The importance of a functional communications system in the provision of health care in rural Alaska.

Paraprofessional health care workers in rural Alaska rely on an intact communication system for guidance in patient care and as a source of support for themselves in performing a difficult job. Though able to function without the system when necessary, the telephone reduces the crushing sense of responsibility and profound isolation experienced by CHAs as they struggle to meet the health care needs of their communities.

Alaska↗
PubMed1992

Lead ingestion associated with ceramic glaze--Alaska, 1992.

In August 1992, a physician notified the Alaska Division of Public Health (ADPH) that three patients at a psychiatric hospital had consumed ceramic glaze during ceramic therapy (i.e., recreation therapy involving the production of ceramic ware), and two of these patients had elevated blood lead levels (BLLs). This report summarizes the ADPH's investigation of these ingestions.

Alaska↗
PubMedDate not supplied

Alaska nursing home takes national role in addressing urinary incontinence.

Urinary incontinence affects over half of all residents in the nation's 25,000 nursing homes. While incontinence assessment, treatment and management techniques have been validated under "laboratory" conditions, the practicality of maintaining the systems pose difficulties for most nursing homes. An evaluation of a new automated system for managing urinary incontinence indicates that a nursing home in Anchorage, Alaska, has successfully implemented and maintained the new system for over ten (10) months. Researchers found that The Mary Conrad Center quickly reduced wetness rates in the target group from 25 percent prior to implementation of the program, to about eight percent and have been able to reduce wetness rates to even lower levels in subsequent months. The evaluation provides critical evidence that nursing homes can implement and maintain the comprehensive system. If further testing in other facilities result in similar findings, the system stands to impact the quality of care for over one million nursing home residents affected by urinary incontinence.

Alaska↗
PubMed1992

HIV infection in American Indians and Alaska Natives: surveys in the Indian Health Service.

A network of surveys of HIV seroprevalence in American Indians and Alaska Natives (AI/AN) was begun in 1989. From July 1, 1989 through June 30, 1991, 37,681 serologic specimens were collected from prenatal and sexually transmitted disease patients in 58 facilities operated or funded by the Indian Health Service. Specimens from AI/AN women receiving initial prenatal care showed an overall HIV prevalence of 0.3/1,000, while specimens obtained during the third trimester of pregnancy showed an overall prevalence of 1.0/1,000. The rate for rural third trimester prenatal patients (0.9/1,000) was similar to that for urban patients (1.1/1,000). HIV rates among third trimester AI/AN patients in three western states were 4 to 8 times higher than rates observed in childbearing women of all races in those states. The overall HIV seroprevalence in AI/AN seeking care for sexually transmitted diseases was 4.5/1,000 for males (urban 10.8/1,000; rural 2.0/1,000) and 0.7/1,000 for females (urban 0.9/1,000; rural 0.6/1,000). Approximately 1,210 to 4,250 (midpoint of range = 2,730) AI/AN in the U.S. are projected from survey findings to be currently infected with HIV. The presence of HIV in multiple specimens from rural areas and the similarity of HIV infection rates for female patients from rural and urban locations provides evidence of diffusion of the HIV epidemic to rural AI/AN, and emphasizes the need for effective HIV prevention for this population.

Adolescent↗
PubMed2005

Outbreak of invasive pneumococcal disease--Alaska, 2003-2004.

In Alaska, statewide laboratory-based surveillance revealed an increase in invasive pneumococcal disease (IPD) in a rural region during 2003-2004. This report summarizes the outbreak, regional trends in serotype-specific pneumococcal carriage, and an assessment of use of standing orders for vaccination. The results of this analysis underscore the preventability of IPD and the importance of vaccination.

Adolescent↗
PubMed2004

Diabetes care among older urban American Indians and Alaska Natives.

OBJECTIVE: To assess the prevalence of, and quality of care for, diabetes mellitus among the understudied, yet growing, population of older, urban American Indians and Alaska Natives (AI/ANs). DESIGN: Medical record review. SETTING: Urban Indian primary care clinic in Seattle, Washington. PATIENTS: All (N = 550) AI/AN patients > or = 50 years of age. MAIN OUTCOMES MEASURES: Provider-documented medical diagnoses and indicators of quality of care of diabetes. RESULTS: Diabetes mellitus was documented in 113 (21%) of the medical records. Persons with diabetes were more likely than those without (P > or = .05) to be obese, and to have hypertension, coronary artery disease, and depression. Most patients with diabetes were treated with either insulin (43%) or oral hypoglycemic medication (39%), but 16% received neither. Screening rates within 12 months were high for glycosylated hemoglobin (72%), lipid profile (84%), and foot examination (72%), but were low for urinalysis (23%), ophthalmology referral (23%), and influenza vaccination (46%). Only 46% of patients had ever received pneumococcal vaccination, and even fewer (26%) had received tuberculin skin testing (24%). Although 65% of patients had ever been referred to a dietitian, only 40% had received exercise counseling. The total number of health problems was the factor most often associated with quality of care indicators. CONCLUSIONS: The prevalence rate of diabetes among this urban clinic population of older AI/ANs was high. Although performance of quality indicators was suboptimal, it was comparable to, or better than, that found in other older populations for many measures.

Aged↗
PubMed2005

Ethical considerations in rural health care: a pilot study of clinicians in Alaska and New Mexico.

To investigate differences in the experiences of rural versus non-rural clinicians, we surveyed caregivers in New Mexico and Alaska regarding ethical aspects of care provision. Consistent with past literature, rural compared to non-rural clinicians perceived patients as having less access to health care resources. They reported more interaction with patients and less awkwardness in relationships with their patients outside of work. Rural clinicians also reported their patients expressed more concern about knowing them in both personal and professional roles, had more concerns over confidentiality, and experienced more embarrassment concerning stigmatizing illnesses. Ethical issues and implications of these results for providing care in rural areas are discussed.

Adult↗
PubMedDate not supplied

Combined antibiogram for hospitals with 50+ beds--Alaska, 2002.

Hospital antibiograms are compiled from facility microbiology laboratories and list specific organism-antimicrobial susceptibility combinations. Antibiograms can then be used by facility health care providers to guide choices of antimicrobials for treatment. For a specific time period, antibiograms from different facilities can be aggregated. These summaries are quick and easy to compile and can provide an overview of antimicrobial susceptibility in a region. We aggregated year 2002 antibiograms from nine Alaska hospitals with 50 or more beds. Data presented here suggest that a combined antibiogram can provide a rough summary of susceptibility estimates statewide, and demonstrate trends in decreasing susceptibility, as seen for methicillin-resistant Staphylococcus aureus. For future antibiogram summaries, other organisms can be added as they gain in relevance or concern, or other antimicrobials added as usage or resistance patterns change.

Alaska↗
PubMedDate not supplied

Corneal transplantation in Alaska Natives (excerpts). 1975.

Since the time of the first corneal transplant in Alaska by Dr. Milo Fritz in 1958, great strides have been made in the field of corneal transplantation surgery. The introduction of fine 10-0 nylon sutures, the operating microscope, microsurgical instrumentation, and recently developed corneal preservation techniques has improved the prognosis in transplantation for all types of corneal disease, including PKC scarring. Our own experience at ANMC suggests that we should expect 80-90% of transplants performed for PKC to remain clear.

Alaska↗
PubMed2006

The epidemic of extreme obesity among American Indian and Alaska Native adults with diabetes.

INTRODUCTION: The purpose of this study was to describe the prevalence of obesity among American Indian and Alaska Native (AI/AN) adults with diabetes and to examine the temporal trends for class I, II, and III obesity in this high-risk group during a 10-year period. METHODS: We used data on body mass index (BMI) from the annual Diabetes Care and Outcomes Audit to estimate the prevalence of class I, II, and III obesity (class I = 30.0-34.9 kg/m2, class II = 35.0-39.9 kg/m2, and class III > or = 40.0 kg/m2) in each year from 1995 through 2004. We also investigated trends in mean BMI during the 10-year period and the role of treatment in these trends using multivariable linear regression models. RESULTS: Obesity was highly prevalent in this population in 2004 (class I, 28.9%; class II, 20.4%; class III, 20.3%). From 1995 through 2004, the percentage of obese adults increased from 16.7% to 20.4% in class II and 11.5% to 20.3% in class III (P < .001), and the mean BMI increased from 32.1 kg/m2 to 34.4 kg/m2. The increase in BMI was greater in the younger age groups. Adjusted mean BMI increased significantly over 10 years for each of three treatment categories. CONCLUSION: Extreme degrees of obesity are a common and increasing problem among AI/AN adults with diabetes. We did not find an association between the type of diabetes treatment and the trend toward extreme degrees of obesity. The increase in extreme obesity could potentially affect the burden of morbidity and mortality among AI/AN adults with diabetes. Effective and culturally appropriate weight management interventions are needed.

Adolescent↗
PubMed1991

Diabetes prevalence in Alaska, 1984-1986.

The prevalence of diabetes in Alaska from 1984 to 1986 was determined through medical records review. Cases were identified from hospital and physician discharge forms and from financial abstracts. As of December 1986, 3,719 Alaskans met the criteria for physician diagnosis of diabetes. The overall age-adjusted prevalence of diagnosed diabetes mellitus, 1,357/100,000, was lower than the U.S. rate of 2,470/100,000. The overall age-adjusted prevalence rates of specific complications and pregnancy among Alaskans with diabetes were retinopathy--167.5/1,000; blindness--24.3/1,000; amputations--19.4/1,000; end stage renal disease--9.7/1,000; pregnancy--50.7/1,000. Limitations in available data sources such as death certificates, hospital records, and subspecialists' medical records provided serious problems in identifying persons with diabetes, especially those in the 30- to 69-year age group who have not yet developed complications requiring hospitalization or subspecialty care. This population perhaps is most in need of services to prevent future complications of diabetes.

Adolescent↗
PubMed1991

Paralytic shellfish poisoning--Massachusetts and Alaska, 1990.

Paralytic shellfish poisoning (PSP) is a foodborne illness caused by consumption of shellfish or broth from cooked shellfish that contain either concentrated saxitoxin, an alkaloid neurotoxin, or related compounds. This report summarizes outbreaks of PSP that occurred in Massachusetts and Alaska in June 1990.

Adult↗
PubMedDate not supplied

Plasmapheresis: first year of experience at Humana Hospital-Alaska.

This report summarizes the first year of experience with therapeutic plasmapheresis at Human Hospital-Alaska. Eleven patients had plasmapheresis; 6 patients with the Guillain-Barré syndrome, and patients with thrombotic thrombocytopenic purpura (TTP), Eaton-Lambert syndrome, myasthenia gravis, post transfusion purpura, and multiple myeloma complicated by hyperviscosity and coagulopathy. Many of our patients appeared to benefit from plasmapheresis, but we also report a variety of complications. Our approach to establishing plasmapheresis in a community hospital setting is discussed.

Adolescent↗
PubMedDate not supplied

Trends and patterns of postneonatal mortality in Alaska 1977 through 1984.

Several determinants of Alaska postneonatal mortality rate were examined to determine whether very low birth weight (less than 1500 g) and low birth weight (1500-2499 g) surviving neonates contributed to the lack of improvement in postneonatal mortality rate. For an eight year period (1977 through 1984), all infant deaths (n = 1020) of the 82,301 resident births were reviewed through vital statistics data. The infant's place of birth, ethnic group, birth weight and age at death were available. Ethnic and rural-specific postneonatal mortality rate (PNMR) significantly improved, but there was no change in birth weight distribution or birth weight-specific postneonatal mortality rate. However, surviving very low birth weight infant proportion of postneonatal mortality has increased from 5% to 8.2% and low birth weight proportion has remained unchanged (15.6%). These proportions were not offset by the decline in normal birth weight (greater than 2500 g) postneonatal mortality rate. This trend suggests that infants born weighing less than 2500 g have slowed the decline of the postneonatal mortality rate.

Alaska↗
PubMedDate not supplied

Respiratory syncytial virus and ribavirin therapy: winter 1987-spring 1988. A report of 74 cases treated at Providence Hospital, Anchorage, Alaska.

Seventy-four pediatric cases of Respiratory Syncytial Virus lower respiratory tract infection were treated at Providence Hospital, Anchorage, Alaska between September 1, 1987 and April 30, 1988. These patients are described with illustrative case reports. Twenty-one patients were treated with Ribavirin and these patients are further analyzed as a special interest group. A disproportionate number of the Ribavirin treated group were Alaskan Natives. In the discussion we address concerns of possible toxicity of Ribavirin and current recommendations for patient selection for treatment with Ribavirin.

Adolescent↗