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PubMed1991

DTP immunization and susceptibility to infectious diseases. Is there a relationship?

A two-part study was carried out in Alaskan Native children to evaluate the potential risk of invasive bacterial disease and the occurrence of minor illnesses after immunization with diphtheria and tetanus toxoids and whole-cell pertussis vaccine (DTP). First, a case-control comparison was performed with 186 children who had invasive Haemophilus influenzae type b or Streptococcus pneumoniae disease (cases) and 186 healthy controls matched for sex, region of residence, birth date, and number of DTP immunizations. The proportion of cases and controls immunized in the 30-day period before onset of disease for cases or reference date for controls was identical, suggesting no association with DTP immunization. In a second analysis, the occurrence of any illness, particularly infectious diseases, in 104 study subjects was compared for the period 30 days before and after 377 DTP immunizations. The rate of illness before immunization was 53%, and after immunization, 43%, again suggesting no causative effects from DTP immunization. Despite the high rates of invasive bacterial disease and nearly compete DTP immunization status in this population, no consistent relationship could be demonstrated between DTP immunization and susceptibility to infectious diseases.

Alaska↗
PubMed2005

Epidemiologic profile of HIV and AIDS among American Indians/Alaska Natives in the USA through 2000.

OBJECTIVES: To describe HIV and AIDS among American Indians/Alaska Natives (AI/ AN) in the USA through 2000. DESIGN: An epidemiologic profile was constructed using HIV/AIDS surveillance, sexually transmitted disease (STD), and seroprevalence data. RESULTS: Although AIDS among AI/AN represents < 1% of cumulative AIDS cases in the USA, in 2000 the AIDS incidence rate (cases per 100,000 population) for AI/AN (11.9) was higher than that for whites (7.3). AI/AN had high rates of chlamydia, gonorrhea, and syphilis from 1996 through 2000; among all females, AI/AN females had the second highest rates of chlamydia, gonorrhea, and syphilis reported during this time period. Of all AIDS cases among AI/AN, 70% were reported by 10 states. CONCLUSIONS: These data demonstrate that the impact of STDs and the potential for an impact of HIV/AIDS among AI/AN are greater than indicated by the relatively small number of AIDS cases in this population. Additional mechanisms are needed to fill gaps in the available data. Coordination among the complex network of healthcare providers, tribes, and federal, state, and local health agencies is needed to improve delivery of information about HIV/AIDS to AI/AN and to ensure access to HIV prevention and treatment programs for AI/AN.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Infant mortality trends and differences between American Indian/Alaska Native infants and white infants in the United States, 1989-1991 and 1998-2000.

OBJECTIVES: To describe changes in infant mortality rates, including birthweight-specific rates and rates by age at death and cause. METHODS: We analyzed US linked birth/infant-death data for 1989-1991 and 1998-2000 for American Indians/Alaska Native (AIAN) and White singleton infants at > or =20 weeks' gestation born to US residents. We calculated birthweight-specific infant mortality rates (deaths in each birthweight category per 1000 live births in that category), and overall and cause-specific infant mortality rates (deaths per 100000 live births) in infancy (0-364 days) and in the neonatal (0-27 days) and postneonatal (28-364 days) periods. RESULTS: Birthweight-specific infant mortality rates declined among AIAN and White infants across all birthweight categories, but AIAN infants generally had higher birthweight-specific infant mortality rates. Infant mortality rates declined for both groups, yet in 1998-2000, AIAN infants were still 1.7 times more likely to die than White infants. Most of the disparity was because of elevated post-neonatal mortality, especially from sudden infant death syndrome, accidents, and pneumonia and influenza. CONCLUSIONS: Although birthweight-specific infant mortality rates and infant mortality rates declined among both AIAN and White infants, disparities in infant mortality persist. Preventable causes of infant mortality identified in this analysis should be targeted to reduce excess deaths among AIAN communities.

Accidents↗
PubMed1984

[Genetic structure of the populations of native inhabitants in the northeastern USSR. III. Asiatic Eskimos and the coast and reindeer Chukchi].

The genetic structure of three Asiatic eskimos subpopulations (402 individuals), five coast chuckchies subpopulations (1793 individuals) and three reindeer chuckchies subpopulations (559 individuals) have been studied for 26 electrophoretic protein systems (33 loci). These are: adenilate-kinase (AK), diaphorase NAD X H (Dia), glyoxalase-1 (GLO-1), glucose-6-phosphate dehydrogenase (6GPT), glutamatpyruvate transaminase (GPT), glutamicoxalate transaminase (GOT), carbonic anhydrase-1 (Ca-1), catalase (Ct), acid phosphatase (AcP), lactate dehydrogenase (loci LDH-A and LDH-B), leucine aminopeptidase (Lap), malatedehydrogenase (MDH), purine nucleoside phosphorylase (PNP), superoxide dismutase (Sod), 6-phosphogluconate dehydrogenase (PGD), phosphoglucomutase (loci PGM1 and PGM2), cholinesterase (loci c1--c5), alkaline phosphatase (Pp), esterase D (EsD), red cell esterase (Est) - 4 loci, albumin (Alb), haptoglobin (Hp), hemoglobine (Hb A and B), group-specific component (Gc), transferrin (Tf), ceruloplasmin (Cp). In addition, AB0 and Rh system blood groups and phenyl thiocarbamide taste sensitivity (PTC) have been studied. 12 of 36 loci are polymorphic (33.33%), heterozygosity for all loci in eskimos, coastal and reindeer chuckchies being 0.118 +/- 0.005, 0.130 +/- 0.002 and 0.120 +/- 0.004, respectively. These estimates do not differ essentially from heterozygosity at these loci for mongoloid groups living further south. The test for interpopulation heterogeneity has permitted to estimate contribution of the loci to the differentiation of these populations. The least heterogeneity has been found at loci where gene frequency distribution is the most specific for these ethnic groups.

ABO Blood-Group System↗
PubMed1984

Children's attitudes toward the elderly: a cross-cultural comparison.

In order to test the hypothesis that children's negative attitudes toward the elderly are unique to the culture of the United States, attitudes of children toward the elderly in four diverse cultures were compared. The Semantic Differential subtest of the CATE (Children's Attitudes Toward the Elderly, 1976) was administered to samples of fourth, fifth, and sixth grade children drawn from the Native Alaskan population of the Aleutian Island (n = 29); mainland United States (n = 60); Australia (n = 39); and Ascunion, Paraguay (n = 69). T statistics were used to compare scores on the total SD for the concept OLD and YOUNG PEOPLE within each culture. Analysis of variance was used to determine differences in attitudes toward the elderly between cultures on the total score of the SD for the concepts OLD and YOUNG PEOPLE, and for analysis of individual items of the SD. The results indicate that children in the Aleutian Islands, Paraguay, and Australia rated young people more positively than they did old people, while children in mainland United States rated old and young people similarly. There were no differences between the cultures in the children's rating of the concept OLD PEOPLE, as measured by the total score of the SD, but children in the Aleutian Islands rated old people more negatively than those in the other cultures on several items of the SD. Children in Australia rated the concept YOUNG PEOPLE more positively than did children in other cultures. The conclusion is reached that negative attitudes toward the elderly are not unique to the United States, but may be more universal to the human experience.

Aged↗
PubMed2003

Birth outcomes among American Indian/Alaska Native women with diabetes in pregnancy.

OBJECTIVE: To describe perinatal outcomes and maternal characteristics among American Indian/Alaska Native (AI/AN) women with diabetes in pregnancy. STUDY DESIGN: A retrospective analysis of live births to AI/AN, African American and white women with diabetes (242,715) during pregnancy for the 1989-1991 period (latest available at the time of study) was conducted utilizing a linked birth/infant death database from the National Center for Health Statistics. AI/AN perinatal outcomes and maternal characteristics were compared to those of African American and white women. Similar analyses compared urban and rural AI/AN populations. RESULTS: AI/AN women were more likely than white women to receive inadequate prenatal care (10.4%), to have higher rates of pregnancy-induced hypertension (9.1%) and to have significantly lower rates of primary cesarean delivery (16.9% vs. 22.3%). The rate of macrosomia among births to AI/AN women (24.2%) was notably higher as compared to that in the white population (17.9%). Rates of musculoskeletal and chromosomal anomalies were also higher among AI/AN women, 9 and 4, respectively, per 1,000 live births, as compared to 6 and 2 per 1,000 for the white population. CONCLUSION: Multiple maternal risk factors and birth outcomes demonstrate the need for further research to evaluate methods of improving care in this population.

Black or African American↗
PubMed2001

Effects of p,p'-DDE on immature cells in culture at concentrations relevant to the Alaskan environment.

Arctic Alaskan Natives who maintain a traditional lifestyle have a disease profile that is significantly different from the general US population. There is concern that food sources containing environmental pollutants may contribute to this profile. In a preliminary study, umbilical cord blood was examined for the presence of several environmental contaminants. All cord blood samples analyzed thus far contain p,p'-DDE (1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene) with an average concentration of 0.33 microg/l. This study was undertaken to ascertain if this concentration of p,p'-DDE had detectable effects on immature cells in culture. NIH 3T3 (embryonic mouse fibroblast) and WS1 (human fetal fibroblast) cultures were exposed to media containing either 1 or 10 times the average cord blood concentration of p,p'-DDE. Initial experiments indicated that exposure to p,p'-DDE resulted in a decrease in the cell number of both cell types. Subsequent analysis revealed that the decrease in cell number was due to cell death in NIH 3T3 cells and to cell-cycle arrest in WS1 cells. Furthermore, p,p'-DDE decreased the long-term survival of NIH 3T3 but not WS1 cells. This study has demonstrated that p,p'-DDE, at relevant environmental concentrations, has significant effects on two immature mammalian cell types in culture. In addition, these results highlight the necessity for further studies to address the specific effects of p,p'-DDE on developing fetal systems.

3T3 Cells↗
PubMed1995

How does IHS relate administratively to the high alcoholism mortality rate?

From 1969 to 1990 the alcoholism mortality rate for American Indians/Alaska Natives (AI/AN) has been steadily decreasing. Compared to the U.S. All Races overall rate decrease of 7.8% in that time period, the AI/AN rate has decreased 33.6%, a remarkable fourfold decrease in the mortality rate due to alcoholism. In the decade from 1978 to 1988 the rate decreased from 64.5/100,000 in 1978 to 37.3/100,000 in 1988, a decrease of 42.2%. The comparable figures for U.S. All Races were 8.1/100,000 in 1978 and 7.0/100,000 in 1988, a decrease of 13.6%. During this decade (1978 to 1988) the Indian Health Service (IHS) embarked upon a major effort to assimilate and to expand alcoholism programs then transferred from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) by incorporating those programs into the IHS health delivery system. The number of programs has more than doubled (158/400) since the transfer was completed in 1983. Funds, moreover, have quadrupled ($20/$82.3 million in 1993). The actual funds expended by IHS from Fiscal Year (FY) 1981 through FY 1993 were $559,916,000. Despite the dramatic increase in numbers of programs and total funds applied to the reduction of alcoholism mortality, available data reveal an increase in alcoholism mortality of 40.3% from 1986 to 1990. This article reviews and questions the relationship of allocations, per capita expenditures, and service components available to reduce alcoholism mortality by IHS Areas in light of the increase in the mortality rate and the fourfold increase in the budget. The data appear to show little relationship of mortality rate with allocations, the number of service components available, or per capita expenditures.

Adult↗
PubMed1997

A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us?

BACKGROUND: Undiagnosed cases of seronegative spondyloarthropathy (Spa) are often observed during epidemiologic studies. OBJECTIVE: To determine the extent of and the reasons for the underdiagnosis of Spa. METHODS: We studied 2 groups of Alaskan native patients with Spa using a standardized protocol that included an interview, physical examination, medical record review, and radiographic and laboratory examinations. One group consisted of patients identified in a communitywide epidemiologic study; the other group consisted of patients from related but geographically separate populations who had been diagnosed by a specialist in the hospital or a specialty clinic. All cases met the current classification criteria for Spa. The clinical and demographic features of the cases in the 2 groups were compared. RESULTS: Fifty-five (72%) of the 76 community cases that we identified in the epidemiologic study had not been diagnosed previously as Spa. Among the undiagnosed patients were 34 (94%) of the 36 women, 11 (65%) of the 17 patients with ankylosing spondylitis, 12 (36%) of the 33 patients with reactive arthritis, and 24 (100%) of those with undifferentiated Spa. The community and specialty clinic patient groups were similar in age of onset of joint and back pain and in overall symptoms. The specialty clinic group had a higher proportion of men, more severe disease, and a higher frequency of iritis. CONCLUSIONS: The diagnosis of Spa was missed more often than not in the primary care setting, probably because most of the cases were of mild or moderate severity and did not fit the classic descriptions of spondyloarthropathic disorders. The higher proportion of men among the specialty clinic cases probably reflects provider expectation as well as a slightly milder disease course in women.

Adolescent↗
PubMed2006

Perceived discrimination in health care among American Indians/Alaska natives.

OBJECTIVES: We compared the prevalence of, and reasons for, perceived discrimination in health care among American Indian/Alaska Natives (AI/ANs) and persons of AI/AN + White heritage to African Americans, Asian Americans, and Whites. DESIGN: Data on perceived discrimination were collected by the 2001 California Health Interview Survey (CHIS). We used chi-square tests to evaluate the prevalence of perceived discrimination and the reasons for perceived discrimination across racial groups. SETTING: The 2001 CHIS, a telephone survey, one of the largest cross-sectional surveys ever conducted in the United States. PARTICIPANTS: Participants in this analysis were adults > or = 18 years of age, interviewed from 55,000 households that took part in the survey. INTERVENTIONS: Participants in the 2001 CHIS were asked "Thinking of your experiences with receiving health care in the past 12 months, have you felt you were discriminated against for any reason?" Respondents who endorsed this item were asked about possible reasons for the discrimination. MAIN OUTCOME MEASURES: 1) Does the prevalence of perceived discrimination in health care differ between AI/ANs, AI/AN + Whites, African Americans, Asian Americans, and Whites? and 2) Do the reasons for perceived discrimination in health care vary by race or ethnicity? RESULTS: Discrimination was perceived by 7.1% of the AI/AN alone group, 8.8% of AI/AN + White respondents, 5.6% of African Americans, 4.3% of Whites, and 2.6% of Asian Americans. After adjusting for covariates, the odds of perceived discrimination were different for AI/AN + White (odds ratio [OR] =2.0, 95% confidence interval [CI] 1.5-2.5) and Asian American (OR = .5, 95% CI .4-.7) when compared to Whites. CONCLUSIONS: AI/ANs, and especially those who identify as AI/AN + White, were the most likely among racial groups to report discrimination in health care.

Adolescent↗
PubMed2006

The use of biota sampling for environmental contaminant analysis for characterization of benthic communities in the Aleutians.

It is increasingly clear that the public, native tribes, and governmental agencies are interested in assessing the well-being of natural resources and ecosystems. This may take the form of understanding species presence, monitoring population status and trends, measuring behavior, or quantifying physiology, biological stresses, or chemical/radiological exposure through biomarkers. Often there is a separation between understanding the biological aspects of species well-being and assessing exposure to contaminants. In this paper we examine the applicability of using scuba sampling aimed primarily at specimen collection for radionuclide analysis to assess species presence/absence and to compare among sampling sites and depths. We were especially interested in whether dive transects could provide information on species presence and potential exposure to environmental contaminants. In June/July 2004 we sampled at 49 depth stations along 19 transects at Amchitka and Kiska Islands in the western Aleutian Islands in the Northern Pacific/Bering Sea region. Amchitka Island, a former World War II U.S. Navy base, was the site of three underground nuclear test shots from 1965 to 1971. Four to six transects were established at three Amchitka sites and two Kiska Sites, and 2 to 4 stations were sampled on each transect. Bottom conditions, weather and currents prevented a complete sampling of all stations. There were interspecific differences in the percent of stations where biota were found and collected, in their occurrence near the three test shots on Amchitka, and in the depth where they were found. There were no significant differences between Amchitka and Kiska Island in the percent of stations where species were found. These data suggest that information gathered incidentally to the collection of specimens for chemical/radiological analysis can prove useful for understanding the presence of benthic organisms along particular transects, at given depths, and at different geographical locations. This information also provides a baseline for the range of organisms that could be exposed to future physical or chemical/radiological stressors. The data are useful for developing future biomonitoring plans to assess biological well-being and chemical/radiological exposure only if they are published and available to the public, public policy makers, and managers. Just as it is critical to select endpoints and bioindicators that are of interest for assessing both human and ecological health, specimens should be collected using a protocol that is useful for both chemical/radiological analysis and biological information.

Alaska↗