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PubMed2006

Redeeming hollow promises: the case for mandatory spending on health care for American Indians and Alaska Natives.

The reliance on discretionary spending for American Indian/ Alaska Native health care has produced a system that is insufficient and unreliable and is associated with ongoing health disparities. Moreover, the gap between mandatory spending on a Medicare beneficiary and discretionary spending on an American Indian/Alaska Native beneficiary has grown dramatically, thus compounding the problem. The budget classification for American Indian/Alaska Native health services should be changed, and health care delivery to this population should be designated as mandatory spending. If a correct structure is in place, mandatory spending is more likely to provide adequate funding that keeps pace with changes in costs and need.

Budgets↗
PubMed2002

Short report: molecular genetic characterization of an unusually severe case of hydatid disease in Alaska caused by the cervid strain of Echinococcus granulosus.

Distinct Echinococcus granulosus life cycle patterns have been described in North America: domestic and sylvatic. Gene sequences of the sylvatic E. granulosus indicate that it represents a separate variant. Case-based data have suggested that the course of sylvatic disease is less severe than that of domestic disease, which led to the recommendation to treat cystic echinococcosis patients in the Arctic by careful medical management rather than by aggressive surgery. We recently reported the first two documented E. granulosus human cases in Alaska, with accompanying severe sequelae. Here we describe the results of molecular genetic analysis of the cyst material of one of the subjects that supported identification of the parasite as the sylvatic (cervid) strain and not the domestic (common sheep strain), which was initially thought to be implicated in these unusually severe Alaskan cases.

Animals↗
PubMed2004

Contextual issues for strategic planning and evaluation of systems of care for American Indian and Alaska Native communities: an introduction to Circles of Care.

This introduction to the evaluation component of the Circles of Care initiative includes background on the nature of the initiative, Center for Mental Health Services support for developing systems of care for youth with emotional disturbances, and an overview of the systems of care approach. The prevalence, unique challenges, and the historical, political, and cultural context of health care delivery for American Indian and Alaska Native peoples are also discussed.

Adolescent↗
PubMed2004

The Circles of Care evaluation: doing participatory evaluation with American Indian and Alaska Native communities.

Little information exists regarding mental health and special needs related to American Indian and Alaska Native (AI-AN) families. In this paper we emphasize the use of oral tradition during the Circles of Care initiative, which was essential in understanding cultural history and historical trauma of AI-ANs while giving a greater understanding of an AI-AN-based definition of severe emotional disturbance (SED). The success of these methods serves as a template for improving systems of care and may be useful in evaluation among a wide range of ethnic communities.

Adolescent↗
PubMed2004

Words have power: (re)-defining serious emotional disturbance for American Indian and Alaska Native children and their families.

Circles of Care grantees were provided the opportunity to develop a locally relevant definition of serious emotional disturbance that would be used to define what type of emotional, behavioral, and mental disability would be required to receive services. After conducting detailed assessments of the definition in the guidance for applicants GFA and the definitions used by others in their respective states, seven of the nine grantees developed their own local, project-specific definitions through the participation of community focus groups and Advisory Councils. The six definitions for SED developed by rural grantees all included American Indian and Alaska Native concepts specific to each tribal community's culture; the urban grantee's definition was purposely focused for reaching out to non-professional members of the community. This opportunity for the communities to redefine SED not only provided each community with a definition which would be more culturally specific, but also proved to be an extraordinarily exercise in empowerment and self-determination.

Adolescent↗
PubMed2004

Mapping pathways to services: description of local service systems for American Indian and Alaska Native children by Circles of Care.

The process of describing existing services for American Indian and Alaska Native children with serious emotional disturbance by the Circles of Care strategic planning initiative is overviewed. We explain why service system description is important and how it helped define the role of evaluation within the initiative. Primary goals and methodologies of the service system description are described. Key findings, challenges and opportunities presented by the findings, and impact on the planning process are described.

Adolescent↗
PubMed1991

Coccidia, X-cell pseudotumors and Ichthyophonus sp. infections in walleye pollock (Theregra chalcogramma) from Auke Bay, Alaska.

One hundred twenty-five walleye pollock (Theragra chalcogramma) were collected from Auke Bay, Alaska (USA) in 1985 and examined for histologic evidence of disease-causing infectious agents in 1987. A Goussia sp.-like coccidium was found in the kidney tubules of 75% and an Eimeria sp.-like coccidium was found in the intestine of 18% of the fish examined. The kidney coccidium was associated with sloughing of the tubular epithelium, peritubular fibrosis and granuloma formation. The intestinal coccidium was associated with severe tissue displacement and inflammation. In addition, X-cell pseudotumors were observed in the pseudobranchs (4%), and the fungus Ichthyophonus sp. was observed in the kidney, intestine or brain of 2% of the pollock.

Animals↗
PubMed2000

Prevalence of selected risk factors for chronic disease and injury among American Indians and Alaska Natives--United States, 1995-1998.

Since the 1950s, morbidity and mortality attributable to infectious diseases among American Indians and Alaska Natives (AIs/ANs) have declined and chronic diseases, especially diabetes, and injury have remained important determinants of poor health (1). Knowledge of the prevalence of behavioral risk factors for chronic disease and injury can be used to form policies and programs to improve the health of AIs/ANs. Based on data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 through 1996, CDC published regional estimates of the prevalence of 10 behavioral risk factors for AIs/ANs (2). This report updates data from the earlier report and focuses on three of the 10 risk factors for chronic disease and injury among AIs/ANs.

Chronic Disease↗
PubMed2000

Prevalence of selected cardiovascular disease risk factors among American Indians and Alaska Natives--United States, 1997.

Heart disease and stroke, the principal causes of cardiovascular disease (CVD), are the first and fifth leading causes of death among American Indians and Alaska Natives (AI/AN) (1,2). Risk factors for CVD frequently cluster, which may increase CVD risk multiplicatively (3). To characterize the prevalence of risk factors for CVD (i.e., hypertension, current cigarette smoking, high cholesterol, obesity, and diabetes) among AI/AN, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated that 63.7% of AI/AN men and 61.4% of AI/AN women who participated in the survey had one or more CVD risk factors.

Adult↗
PubMed2003

Photoenhanced toxicity of aqueous phase and chemically dispersed weathered Alaska North Slope crude oil to Pacific herring eggs and larvae.

The photoenhanced toxicity of weathered Alaska North Slope crude oil (ANS) was investigated in the eggs and larvae of Pacific herring (Clupea pallasi) with and without the chemical dispersant Corexit 9527. Oil alone was acutely toxic to larvae at aqueous concentrations below 50 microg/L total polycyclic aromatic hydrocarbons (tPAH), and median lethal (LC50s) and effective concentrations (EC50s) decreased with time after initial oil exposure. Brief exposure to sunlight (approximately 2.5 h/d for 2 d) significantly increased toxicity 1.5- to 48-fold over control lighting. Photoenhanced toxicity only occurred when oil was present in larval tissue and increased with increasing tPAH concentration in tissue. Ultraviolet radiation A (UVA) treatments were less potent than natural sunlight, and UVA + sunlight caused greater toxicity than sunlight alone. The toxicity of chemically dispersed oil was similar to oil alone in control and UVA treatments, but oil + dispersant was significantly more toxic in the sunlight treatments. The chemical dispersant appeared to accelerate PAH dissolution into the aqueous phase, resulting in more rapid toxicity. In oil + dispersant exposures, the 96-h no-observed-effect concentrations in the UVA + sunlight treatment were 0.2 microg/L tPAH and 0.01 microg/g tPAH. Exposure of herring eggs to oil caused yolk sac edema, but eggs were not exposed to sun and UVA treatment did not cause phototoxicity. These results are consistent with the hypothesis that weathered ANS is phototoxic and that UV can be a significant and causative factor in the mortality of early life stages of herring exposed to oil and chemically dispersed oil.

Animals↗
PubMed2005

Perspectives on suicide prevention among American Indian and Alaska native children and adolescents: a call for help.

Suicide rates among American Indian Alaska Native (AIAN) children and adolescents are the highest in the United States. Risk factors for suicide among AIAN youth include: strained interpersonal relationships, family instability, depression, low self-esteem, and alcohol use or substance abuse. Protective factors include: caring family relationships, supportive tribal leaders, and positive school experiences. Carefully planned, culturally sensitive, comprehensive programs that address the social determinants of health outcomes such as poverty, school failure, familial conflicts, and limited access to health care, should be the focus of blueprints for change for these vulnerable children. Moreover, culturally competent providers are key elements associated with reducing the suicide rates among AIAN children and adolescents.

Adolescent↗
PubMed1995

Research on excess deaths among American Indians and Alaska Natives: a critical review.

American Indians and Alaska Natives die younger and at higher rates proportionately than members of the general United States population. Causes of death among Native peoples in the U.S. have been the subject of numerous studies by health care professionals and social scientists. Many of these deaths are considered excess deaths, that is, deaths that occur statistically beyond the rate of incidence of the larger population. This paper examines 46 studies of excess deaths published within five years (1987 to 1993) and based on data gathered within ten years (1982 to 1992) and critiques the studies for methodology and context. Existing studies of excess death among Native peoples are limited by a lack of definitional clarity, ethnic misclassifications, lack of multidisciplinary and Native representation on research terms, superficial analysis of statistical findings, overrepresentation of data for some tribes and underrepresentation for others, bias for quantitative research methods and unbalanced prioritization.

Bias↗
PubMed1994

Health status of urban American Indians and Alaska Natives. A population-based study.

OBJECTIVE: To use vital statistics and communicable disease reports to characterize the health status of an urban American Indian and Alaska Native (AI/AN) population and compare it with urban whites and African Americans and with AI/ANs living on or near rural reservations. DESIGN: Descriptive analysis of routinely reported data. SETTING: One metropolitan county and seven rural counties with reservation land in Washington State. SUBJECTS: All reported births, deaths, and cases of selected communicable diseases occurring in the eight counties from 1981 through 1990. MAIN OUTCOME MEASURES: Low birth weight, infant mortality, and prevalence of risk factors for poor birth outcomes; age-specific and cause-specific mortality; rates of reported hepatitis A and hepatitis B, tuberculosis, and sexually transmitted diseases. RESULTS: Urban AI/ANs had a much higher rate of low birth weight compared with urban whites and rural AI/ANs and had a higher rate of infant mortality than urban whites. During the 10 years, urban AI/AN infant mortality rates increased from 9.6 per 1000 live births to 18.6 per 1000 live births compared with no trend among the other populations. Compared with rural AI/AN mothers, urban AI/AN mothers were 50% more likely to receive late or no prenatal care during pregnancy. Relative to urban whites, urban AI/AN risk factors for poor birth outcomes (delayed prenatal care, adolescent age, and use of tobacco and alcohol) were more common and closely resembled the prevalence among the African-American population except for a higher rate of alcohol use among AI/ANs. Compared with urban whites, urban AI/AN mortality rates were higher in every age group except the elderly. Differences between urban whites and AI/ANs were largest for injury- and alcohol-related deaths. All-cause mortality was lower among urban AI/ANs compared with rural AI/ANs and urban African Americans, although injury- and alcohol-related deaths were higher for AI/ANs. All communicable diseases studied were significantly (P < .05) more common among urban AI/ANs compared with whites. Tuberculosis rates were highest in the urban AI/AN group, but rates of sexually transmitted diseases were intermediate between urban whites and African Americans. CONCLUSIONS: In this urban area, great disparities exist between the health of AI/ANs and whites across almost every health dimension we measured. No consistent pattern was found in the comparison of health indicators between urban and rural AI/ANs, though rural AI/ANs had lower rates of low birth weight and higher rates of timely prenatal care use. The poor health status of urban AI/AN people requires greater attention from federal, state, and local health authorities.

Adolescent↗