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PubMedDate not supplied

Over-representation of Samoan/Pacific Islanders among patients with methicillin-resistant Staphylococcus aureus (MRSA) infections at a large family practice clinic in Anchorage, Alaska, 1996-2000.

Two pediatricians in Anchorage observed that among patients of Samoan/Pacific Islander (S/PI) descent, bacterial wound cultures that grew Staphylococcus aureus often yielded methicillin-resistant isolates. The Alaska Section of Epidemiology performed chart reviews of patients that visited a large family practice clinic in Anchorage, Alaska, from 1996 through April 2000, and who were diagnosed with a skin infection. Eight of 204 patients were identified with culture-confirmed MRSA infections. Eighty percent (4 of 5) of S/PI patients had resistant isolates compared with 12% (4 of 34) of non S/PI patients (Yates corrected chi2 = 8.61, p-value = 0.003). Although subject to limitations, these data support similar findings documented by other studies that suggest MRSA infections disproportionately affect persons of S/PI origin. This study also suggests that it would be prudent to reduce the threshold of clinical suspicion for obtaining a skin culture among S/PI patients in Alaska, and avoid beta-lactam antibiotics until culture results are received.

Alaska↗
PubMed2006

Meeting the needs of regional minority groups: the University of Washington's programs to increase the American Indian and Alaskan native physician workforce.

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.

Alaska↗
PubMed2002

Fetal alcohol syndrome--Alaska, Arizona, Colorado, and New York, 1995-1997.

Fetal alcohol syndrome (FAS) is caused by maternal alcohol use during pregnancy and is one of the leading causes of preventable birth defects and developmental disabilities in the United States. FAS is diagnosed on the basis of a combination of growth deficiency (pre- or postnatal), central nervous system (CNS) dysfunction, facial dysmorphology, and maternal alcohol use during pregnancy. Estimates of the prevalence of FAS vary from 0.2 to 1.0 per 1,000 live-born infants. This variation is due, in part, to the small size of the populations studied, varying case definitions, and different surveillance methods. In addition, differences have been noted among racial/ethnic populations. To monitor the occurrence of FAS, CDC collaborated with five states (Alaska, Arizona, Colorado, New York, and Wisconsin*) to develop the Fetal Alcohol Syndrome Surveillance Network (FASSNet). This report summarizes the results of an analysis of FASSNet data on children born during 1995-1997, which indicate that FAS rates in Alaska, Arizona, Colorado, and New York ranged from 0.3 to 1.5 per 1,000 live-born infants and were highest for black and American Indian/Alaska Native populations. This study demonstrates that FASSNet is a useful tool that enables health care professionals to monitor the occurrence of FAS and to evaluate the impact of prevention, education, and intervention efforts.

Alaska↗
PubMed1975

An evaluation of alcoholism treatment services for Alaskan natives.

Using chart-review procedures, the authors examined the management of patients with a recognized alcohol problem in 12 medical facilities and 20 alcoholism programs throughout Alaska. The evaluation, which covered a one-year period, focused on the service delivery system rather than on treatment outcome, and sought to determine if problems of alcohol abuse were being solved. The authors found that a treatment plan was developed, followed up, and evaluated for 8 per cent of the problem drinkers treated in medical facilities and for 16.7 per cent of those in alcohol programs.

Alaska↗
PubMed2007

Seal and whale meat: two newly recognized food allergies.

BACKGROUND: Alaska's marine mammals compose a large portion of the diet of indigenous coastal Alaskan people. Bowhead whales (Balaena mysticetus) and bearded seals (Erignathus barbatus), inhabitants of the Bering and Beaufort seas along Alaska's western and northern coasts, are 2 of the most important subsistence species, serving as major food sources to the native population. OBJECTIVE: To describe an Inupiaq boy with symptoms consistent with an IgE-mediated food allergy after ingestion of bowhead whale and bearded seal meat. METHODS: Extracts of cooked bowhead whale and bearded seal were prepared, lyophilized, and evaluated for protein content. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed for each extract, followed by transfer to nitrocellulose and IgE immunoblots. Skin prick testing was conducted using reconstituted extracts of 1:10 wt/vol dilution. RESULTS: Immunoblots revealed serum specific IgE binding with the extracts of bowhead whale and bearded seal meat. Protein bands of approximately 25, 40, 50, and 90 kDa were found in the seal meat. Protein bands of 55 and 90 kDa were found in the whale meat. Skin prick test results were positive to whale and seal extracts with appropriate positive and negative controls. Ten control subjects had negative reactions to both extracts. CONCLUSION: A patient with moderate anaphylaxis to bowhead whale and bearded seal meat demonstrated serum specific IgE by means of immunoblot and positive skin prick test results. This is the first known reported case of specific IgE to these species.

Alaska↗
PubMed1997

Protection provided by hepatitis B vaccine in a Yupik Eskimo population--results of a 10-year study.

A hepatitis B virus vaccine demonstration project was conducted in southwest Alaska in 1981-1982 to determine the immunogenicity and efficacy of the vaccine. A total of 1630 susceptible persons in the Alaskan Native population were vaccinated with the recommended three-dose regimen of plasma-derived hepatitis B vaccine, and 94% demonstrated antibody to hepatitis B surface antigen (anti-HBs) at levels > or = 10 mIU/mL. After 10 years of follow-up, 76% of those immunized had anti-HBs levels > or = 10 mIU. During the 10 years following the first dose of vaccine, 13 study participants developed antibody to hepatitis B core antigen (10 vaccine responders, 3 nonresponders), and none developed sustained HBs positivity or had clinical hepatitis. These data suggest that immunization with hepatitis B vaccine continues to provide high levels of protection from clinical disease for at least 10 years.

Adolescent↗
PubMed1977

Nasopharyngeal cancer in Greenland. The incidence in an Arctic Eskimo population.

Nasopharyngeal cancer is very common among the Chinese in various parts of the world, particularly Southern China, and frequent in certain other Mongoloid groups in Southeast Asia. Also, the incidence among the Eskimos of the western Canadian Arctic and Alaska is considerably higher than would be expected. Ths paper reports for the first time the incidence of nasopharyngeal cancer among native Greenlanders, an Eskimo population with some admixture of Caucasian blood. During 1955-1976, thirty-five cases of nasopharyngeal cancer were diagnosed. Ninety-four per cent (33 cases) were squamous cell carcinomas, including lymphoepitheliomas. Incidence rates 1965-1976, age adjusted to the "world" population distribution, were 12.3 and 8.5 per 100,000 per annum for males and females respectively. These rates are among the highest recorded in the world and significantly higher than among the Caucasian population in Denmark. Compared with other high risk populations nasopharyngeal cancer among Greenlanders had an older age distribution and a lower male-to-female sex ratio. An additional 11 cases with malignant involvement, seeminly confined only to cervical lymph nodes, may have included some undiagnosed nasopharyngeal cancers. Thus the calculated incidence rates of this study could represent only minimum rates. Further research is needed especially with regard to the HL-A profile and to possible traces of Epstein-Barr virus infection.

Adolescent↗
PubMedDate not supplied

Diabetes care: a comparison of management systems.

During 1997, the Alaska Area Diabetes Program audited a sample of 837 charts from among the 1373 individuals receiving regular diabetes care at facilities serving predominantly American Indians/Alaska Natives. Charts were evaluated for the delivery of American Diabetes Association Standards of Care. Results of the audit showed a great deal of variability among facilities. Facilities which scored highly in the audit were more likely to use an organized multidisciplinary team approach that included coordinated clinic appointments with multiple providers on the same day, maintenance of a diabetes registry, proactive preclinic preparation, flow-sheet use, intensive individual nutritional counseling, a case manager or field clinic coordinator system with standing orders, and strong self-management support.

Alaska↗
PubMedDate not supplied

Smokeless tobacco use among Native American school children.

Seven published and two unpublished surveys of Native American school children's use of smokeless tobacco (ST) are reviewed. The surveys represent school children in the States of South Dakota, Montana, Nebraska, Washington, Arizona, New Mexico, and Alaska. This review describes and discusses the survey methods, prevalence, duration, and intensity of ST use, and ST health effects documented in these studies. Prevalence of regular ST use ranges from 18 percent in kindergartners through 6th graders to 55.9 percent among 9th and 10th graders. In two studies that surveyed kindergartners, regular use was reported at 13 percent in one study and 21 percent in the other. Comparisons to use by non-Native Americans, as reported in surveys, demonstrate the severity of the problem in Native American communities. There appear to be three significant findings related to Native American ST use: (a) young age of onset of ST use, (b) similar prevalence of use among adolescent boys and girls, and (c) higher overall prevalence of ST use when compared to non-Native American populations. Acceptance of the habit, peer pressure, and addiction seem to be contributing to the high ST use in Native American communities.

Child↗
PubMed1998

Prevalence of rheumatoid arthritis in circumpolar native populations.

OBJECTIVE: To compare the prevalence of rheumatoid arthritis (RA) in related, but geographically separate, indigenous circumpolar populations. METHODS: Cases were identified by community survey in Russia and by examination of cases located through arthritis registries, a computerized patient information database, and query of local health care providers in Alaska. All possible cases were verified by examination and application of the American College of Rheumatology 1987 criteria. RESULTS: The prevalence rates of RA (age standardized to US population of 1980) varied from 0.62% in the Alaskan Yupik to 1.78% in the Alaskan Inupiat. The Russian Chukchi rate was 0.73% and that of the Siberian Eskimo was 1.42%. CONCLUSION: The Alaskan Yupik Eskimo and Chukchi natives had prevalence rates of RA within the usual range of North American Caucasian groups, in contrast to the Russian Siberian Eskimo and the Alaskan Inupiat Eskimo of the Barrow region, whose high rates approached those of unrelated North American native groups living in very different environments. The Alaskan Inupiat rate was significantly higher than that of the Alaskan Yupik (OR = 2.51, 95% CI 1.25-5.07; p = 0.013), but statistical inferences are limited in the Russian study populations by the small case numbers. The high prevalence rates probably have a genetic basis, although an environmental influence cannot be excluded.

Adult↗
PubMed2004

Adolescent mothers: a challenge for First Nations.

OBJECTIVES: Adolescent pregnancy is a growing Public Health problem in Greenland, resulting in higher risk of mortality of mothers and their children. Since social and cultural aspects are associated with adolescent pregnancy, a closer look was taken at the situation of adolescent mothers in Greenland and in Native American communities. METHODS AND RESULTS: Adolescent pregnancies and birth rates were followed in Greenland and in the First Nation communities in Alaska. Adolescent pregnancies decreased during the 1990s in both communities, but increased in 2000, bringing up the birth rate to 79 and 92 babies per 1,000 girls aged 15-19 yrs in Greenland in the U.S., respectively. CONCLUSIONS: A mentoring program to delay adolescent pregnancy and parenting, shown to be effective in African American and Latino communities, could be also used in the Greenlandic setting.

Adolescent↗
PubMed1986

The HLA system in Inupiat and Central Yupik Alaskan Eskimos.

We have studied HLA antigen profiles of the Inupiaq and Yupik-speaking peoples, two of the four Eskimo linguistic groups residing in Alaska. A relatively restricted polymorphism of HLA-A and -B locus antigens was noted. Only 35% of A locus specificities and 37% of B locus specificities tested for were detected in each population. The most common A locus alleles were A2, A24, and A28; the most common B locus alleles were B51(5), B27, B35, Bw60(40), Bw61(40), and Bw62(15). The antigens Cw3 (75 and 69%) and DR4 (81 and 67%) were found in high frequency in both groups. HLA-DR1, DR2, and DR7 were detected infrequently, while DR3 was not detected at all. DR4 was frequently associated in both Inupiats and Yupiks with Dw4, a specificity that was thought to occur only in Caucasian populations. A statistically significant difference between Inupiats and Yupiks was found for polymorphism at the A locus, but no significant differences were found for polymorphisms at the B, C, D, or DR loci. Analysis of HLA linkage disequilibrium revealed the presence of several novel haplotypes not previously described in other populations, suggesting that the selective factors responsible for positive associations observed in these Native Alaskans were probably distinct.

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↗
PubMed2005

Is Pacific race a retinopathy of prematurity risk factor?

BACKGROUND: Black race affords some protection from retinopathy of prematurity (ROP), but more ROP was previously found in another darkly pigmented race, the Alaskan natives. DESIGN: From fall 1989 through summer 2003, all Alaskan infants with a birth weight of 1500 g or less were examined, documenting mother's stated race, prenatal care, and neonatal intensive care unit course. RESULTS: Retinopathy of prematurity was classified as to predefined threshold for peripheral ablative treatment (region of avascular retina and fibrovascular ridge and vessel tortuosity) in 873 infants. Threshold ROP was more prevalent in Alaskan natives (24.9%) and Asians (15.9%) (10% overall), with no significant difference between Alaskan natives and Asians (P = .24). Alaskan native males had more threshold ROP (69%) compared with non-Alaskan native males (51%). Compared with threshold nonnatives, Alaskan native threshold infants had greater birth weights (829 +/- 222 vs 704 +/- 186 g), required less time on ventilation (46 +/- 22 vs 70 +/- 75 days), and progressed to treatment at a younger age (35.5 +/- 2.2 vs 36.2 +/- 2.6 weeks' gestational age) (data are given as mean +/- SD). CONCLUSIONS: In this limited study, we find increased risk of threshold ROP in 2 northern Pacific races. Threshold Alaskan natives had similar or better prenatal and neonatal intensive care unit variables than did threshold nonnatives; however, Alaskan native males were still at a greater risk.

Alaska↗