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PubMed2002

Trends in diabetes prevalence among American Indian and Alaska native children, adolescents, and young adults.

OBJECTIVES: This study determined trends in diabetes prevalence among young American Indians and Alaska Natives. METHODS: American Indian and Alaska Native children (< 15 years), adolescents (15-19 years), and young adults (20-34 years) with diabetes were identified from the Indian Health Service (IHS) outpatient database. The population living within IHS contract health service delivery areas was determined from census data. RESULTS: From 1990 to 1998, the total number of young American Indians and Alaska Natives with diagnosed diabetes increased by 71% (4534 to 7736); prevalence increased by 46% (6.4 per 1000 to 9.3 per 1000 population). Increases in prevalence were greater among adolescents and among young men. CONCLUSIONS: Diabetes should be considered a major public health problem among young American Indians and Alaska Natives.

Adolescent↗
PubMed1998

Traditional and western healing practices for alcoholism in American Indians and Alaska Natives.

The American Indian and Alaska Native population is a culturally diverse population with a current census of 1,959,000. Prior to White contact, there was historically little use of alcoholic beverages except for American Indians in the Southwest. After White contact, use and misuse of alcohol escalated rapidly; however, the prevalence, patterns, and problems of drinking alcoholic beverages vary enormously even in tribes closely linked geographically. American Indians and Alaska Natives have preserved and revitalized a number of traditional healing practices and applied these to the treatment of alcohol-related problems. These healing practices include the following: nativistic movements, sacred dances, sweat lodges, talking circle, four circles, and cultural enhancement programs. Additionally, Western treatment approaches have been applied in the treatment of problems related to alcohol, such as medication for detoxification, disulfiram (Antabuse), Alcoholics Anonymous, and behavioral interventions. Several investigators have completed a small number of naturalistic follow-up studies, but no one has undertaken a randomized controlled trial looking at specific methods of alcohol treatment in American Indians or Alaska Natives. American Indian and Alaska Native communities have adapted and integrated both Traditional and Western approaches to fit their own unique sociocultural needs.

Adult↗
PubMed2000

Genetic diversity and epidemiology of infectious hematopoietic necrosis virus in Alaska.

Forty-two infectious hematopoietic necrosis virus (IHNV) isolates from Alaska were analyzed using the ribonuclease protection assay (RPA) and nucleotide sequencing. RPA analyses, utilizing 4 probes, N5, N3 (N gene), GF (G gene), and NV (NV gene), determined that the haplotypes of all 3 genes demonstrated a consistent spatial pattern. Virus isolates belonging to the most common haplotype groups were distributed throughout Alaska, whereas isolates in small haplotype groups were obtained from only 1 site (hatchery, lake, etc.). The temporal pattern of the GF haplotypes suggested a 'genetic acclimation' of the G gene, possibly due to positive selection on the glycoprotein. A pairwise comparison of the sequence data determined that the maximum nucleotide diversity of the isolates was 2.75% (10 mismatches) for the NV gene, and 1.99% (6 mismatches) for a 301 base pair region of the G gene, indicating that the genetic diversity of IHNV within Alaska is notably lower than in the more southern portions of the IHNV North American range. Phylogenetic analysis of representative Alaskan sequences and sequences of 12 previously characterized IHNV strains from Washington, Oregon, Idaho, California (USA) and British Columbia (Canada) distinguished the isolates into clusters that correlated with geographic origin and indicated that the Alaskan and British Columbia isolates may have a common viral ancestral lineage. Comparisons of multiple isolates from the same site provided epidemiological insights into viral transmission patterns and indicated that viral evolution, viral introduction, and genetic stasis were the mechanisms involved with IHN virus population dynamics in Alaska. The examples of genetic stasis and the overall low sequence heterogeneity of the Alaskan isolates suggested that they are evolutionarily constrained. This study establishes a baseline of genetic fingerprint patterns and sequence groups representing the genetic diversity of Alaskan IHNV isolates. This information could be used to determine the source of an IHN outbreak and to facilitate decisions in fisheries management of Alaskan salmonid stocks.

Alaska↗
PubMed2004

Reduction of amputation rates among Alaska Natives with diabetes following the development of a high-risk foot program.

OBJECTIVE: The prevalence of diabetes is increasing rapidly among Alaska's Indian, Eskimo and Aleut populations. Approximately half the Native people with diabetes have no road access to hospitals or physicians, presenting a challenge in the attempt to prevent lower extremity amputation as a complication. In late 1998 funding became available for diabetes prevention and treatment among Native Americans. The tribal health corporations in Alaska decided to use a portion of this funding to implement a high-risk foot program to decrease the amputation rate. PROGRAM DESIGN: The program initially involved a surgical podiatrist who provided training to local staff and performed preventive and reconstructive surgery on several patients with impending amputations. The program then provided training for a physical therapist to become a certified pedorthist. This individual established the long-term maintenance phase of the program by conducting diabetic foot clinics routinely at the Alaska Native Medical Center, a referral center in Anchorage. He also travels to other regions of the state to provide training for village and hospital-based health care providers and to conduct field clinics. A system was established in a common database management program to track the patients' foot conditions. Patient education is emphasized. RESULTS: The overall amputation incidence among all Alaska Native patients with diabetes decreased from 7.6/1,000 in the pre-program period (1996 to 1998) to 2.7/1,000 in the post-program period (1999-2001) (p<.001). The rate among Aleuts, who previously had the highest amputation incidence, decreased from 17.4/1,000 to 3.1/1,000 over the same time periods (p<.001). Among people who had had diabetes at least 10 years, the overall amputation incidence decreased from 16.4/1,000 to 6.8/1,000 (p=.021); among Aleuts the rate fell from 24.5/1,000 to 2.6/1,000 (p=.01). CONCLUSIONS: Though longer follow-up is needed, these data suggest that even in populations living in isolated regions, diabetic amputations can be prevented by a coordinated system to identify high-risk feet and provide preventive treatment and education in the context of a comprehensive diabetes management program in an integrated health system.

Alaska↗
PubMed2004

Scientific worker and licensed professional deaths in Alaska, 1990-2002.

OBJECTIVES: Between 1990-2002, 797 Alaskans died while working. After a scientific survey team member drowned, we examined the hazards of traumatic death to scientific and professional workers in Alaska. STUDY DESIGN: Surveillance and analysis methods for acute traumatic occupational injuries: The Alaska Occupational Injury Surveillance System (AOISS) uses direct investigation, jurisdictional agency reports, and death certificates to gather data for active surveillance on occupational injury deaths in Alaska. We searched AOISS for deaths which occurred while engaged in scientific or professional work. Commercial pilots, fishermen, loggers, taxi drivers and miners were excluded, as these have been previously studied. RESULTS: During 1990-2002, 85 scientific/professional worker deaths (including 2 suicides) occurred. Fish, game, and mountaineering guides accounted for 28 (33%) of the worker deaths, followed by biologists, who accounted for 11 (13%). Aircraft crashes accounted for 42 (49%) of all these deaths, followed by drownings, 12 (14%), and falls, 9 (11%). A seismologist was fatally mauled by a bear. Of the 14 hunting guide fatalities, 11 were the result of aircraft crashes, one was a suicide, one was a drowning, and one resulted from a motor vehicle crash. Of the 11 hunting guide fatalities, eight died in aircraft crashes, one drowned, one walked into an aircraft prop, and one sustained a fatal head injury in a fall. CONCLUSIONS: Scientific and professional workers in Alaska experienced a substantial number of fatalities from traumatic injury. Nearly half of these deaths occurred in aircraft crashes.

Accidents, Occupational↗
PubMed2004

The role of hypothermia and drowning in commercial fishing deaths in Alaska, 1990-2002.

OBJECTIVES: To describe the patterns associated with cold-water immersion and drowning in commercial fishermen in Alaska from 1990 through 2002. STUDY DESIGN: This is a retrospective study using data from the Alaska Occupational Surveillance System (AOISS), a database with records from all occupational mortalities occurring in Alaska from 1990 on. METHODS: We extracted and analyzed all records describing deaths from drowning or hypothermia to commercial fishermen in Alaska from 1990 through 2002 that were registered within AOISS. We also used a subset of records from AOISS to compare use of Personal Flotation Devices (PFDs) between the target population and survivors of fatal events. RESULTS: There were 228 deaths resulting from cold-water immersion and subsequent drowning in the target population for the time period studied. Victims were far less likely to have used PFDs than were survivors of events where cold-water drowning occurred. CONCLUSION: The strong protective association seen with the use of PFDs, particularly immersion suits, in surviving cold-water events indicates that many of the events that led to deaths in the target population could well have been survivable.

Accidents, Occupational↗
PubMed2005

A genetic and epidemiologic study of cardiovascular disease in Alaska natives (GOCADAN): design and methods.

This article is a report of the design and methods of the Genetics of Coronary Artery Disease in Alaska Natives (GOCADAN) Study. This longitudinal, population-based study was initiated to investigate the genetic determinants of cardiovascular disease and its risk factors. Between October 2000 and April 2004, this family study enrolled 1,214 Eskimos from several coastal villages in the Norton Sound region of Western Alaska. Examinations included a physical, laboratory determinations, and measures of subclinical disease. This study will generate a genome-wide scan for loci influencing cardiovascular disease-related traits. Relations between subclinical atherosclerosis and markers of inflammation will be examined using historic and newly drawn samples. The study will provide data on CVD prevalence, risk factors and the relative contribution of genetic and environmental determinants in Alaska Native peoples. Data from this study will contribute to the delivery of health-care and prevention of CVD in Alaska Eskimos and other populations.

Adult↗
PubMed2000

HIV drug and sex risk behaviors among American Indian and Alaska Native drug users: gender and site differences.

Little research has been conducted on HIV drug and sex risk behaviors of American Indians and Alaska Natives who use illicit drugs. Data from studies conducted with other ethnic groups indicates differences in HIV drug and sex risk behaviors of men and women and between drug users from different regions, cities, communities, and intervention sites. This study examines whether these differences in HIV drug and sex risk behaviors also exist for American Indians and Alaska Natives. Results indicate that risk behaviors of American Indians and Alaska Natives do differ like that of other ethnic groups. In particular American Indian and Alaska Native women reported engaging in significantly greater levels of some drug and many sex risk behaviors than men. Significant differences between intervention sites were also found for intensity of use of various drugs and for some HIV drug risk behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed1998

C. Earl Albrecht and the struggle against tuberculosis in Alaska.

This paper outlines the contributions of C. Earl Albrecht in tuberculosis control in Alaska during his term as Territorial Commissioner of Health from 1945 to 1956. Tuberculosis, called the "Scourge of Alaska," had spread by the end of World War II to every corner of Alaska, with especially devastating effects on the Alaska Natives. When Dr. Albrecht became commissioner, the epidemic was at its peak. With an obvious zest for battle, he organized a campaign on many fronts, with initial emphasis on case-finding, establishing a tuberculosis register, and making available hospital beds both for orthopedic and pulmonary tuberculosis. Later, BCG vaccination, ambulatory chemotherapy, and chemoprophylaxis were added to the battle plan. The results were strikingly successful. He became an eloquent spokesman and advocate for health in both Juneau and Washington, and was successful in obtaining greatly increased territorial and federal appropriations, not to mention surplus military buildings, ships, and supplies. He was also notably effective in bringing together into a functional team such diverse agencies as the U.S. Public Health Service, the Bureau of Indian Affairs, the Territorial Department of Health, and various voluntary health organizations.

Alaska↗
PubMedDate not supplied

ADH and ALDH polymorphisms among Alaska Natives entering treatment for alcoholism.

The alcohol dehydrogenase (ADHs) and aldehyde dehydrogenases (ALDHs) involved in alcohol metabolism are polymorphic. Different alleles encode subunits of the enzymes that are related to differences in alcohol metabolism with different ethnic groups. This study examined the allele frequencies at the ADH1, ADH2, ADH3 and ALDH2 loci in Alaska Natives entering treatment for alcoholism to determine if allele frequencies at these loci differ among five distinct Alaska Native groups: Yupik and Inupiat Eskimos, Athabascan, Tlingit and Aleut. It was found that all persons were homozygous for the ADH1*1, ADH2*1 and ALDH2*1 alleles. Variations, however, were found for the allele distribution of the ADH3 genotype. Comparison with a general population sample found no differences in allele distributions for ADHs and ALDH2*1, but differences were found when comparisons were made with four Asian Groups. The study's findings suggest that the Alaska Natives are not protected from the risk of alcoholism in the same way that Asians who possess the ALDH2*2 genotype are considered to have a negative risk factor. Nor, does there appear to be any generalized differences between Alaska Native alcoholics and members of the general population with respect to the ALDH and ADH polymorphisms studied herein.

Adolescent↗
PubMedDate not supplied

Emerging infectious diseases in Alaska and the Arctic: a review and a strategy for the 21st century.

Emergence of new, previously unknown, and drug-resistant infectious diseases pose a major threat to global health. The emergence of infectious diseases in Alaska and the Arctic parallels the resurgence of infectious diseases worldwide. The Centers for Disease Control and Prevention has developed a strategy to revitalize the capacity to protect the public from emerging infectious diseases by improving four major public health activities: surveillance and response, applied research, infrastructure and training, and prevention and control. The plan targets high-priority emerging infectious disease problems and particular groups of people at increased risk. These target areas encompass a number of diseases of special concern in Alaska, such as drug-resistant Streptococcus pneumoniae infections, foodborne botulism, alveolar hydatid disease, viral hepatitis, Helicobacter pylori infections, Haemophilus influenzae type b bacteremia and meningitis, and infections of immunocompromised persons, pregnant women and newborns, and tourists. To address these and other emerging infectious disease issues, including the threat of bioterrorism in Alaska and the Arctic, future issues of Alaska Medicine will include updates on specific emerging infectious diseases for health care providers, clinical laboratory workers, and community public health professionals who form the front lines for recognizing, treating, and preventing emerging infectious diseases.

Alaska↗
PubMedDate not supplied

Serious and fatal firearm injuries among children and adolescents in Alaska: 1991-1997.

STUDY OBJECTIVE: To describe demographics, causal factors, intent, and incident locations of serious and fatal firearm injuries among children and adolescents in Alaska, for the years 1991 through 1997. METHODS: Data from the Alaska Trauma Registry plus Vital Statistics death certificates were reviewed for a seven-year period (1991-1997). Data elements included are: intent (ICD 9-CM E-Codes and narratives); age group; region of incident; place of occurrence; alcohol or drug involvement; type of firearm used; and perpetrator. RESULTS: During the seven-year study period, 222 children and adolescents ages 0-19 years were admitted to a hospital for a non-fatal firearm injury, plus 165 others received fatal firearm injuries. Of these 387 serious and fatal injuries, 34.9% (135) were determined to be unintentional, 36.4% (141) were suicides or suicide attempts, 23.3% (90) were homicide/assaults, 0.5% (2) were legal intervention, and for 4.9% (19) intent was unknown. Rates of serious and fatal firearm injuries per 100,000 youth for the six-year study period ranged from 14 in the Fairbanks North Star Borough and the Kenai Peninsula Borough to 105 in the Yukon-Kuskokwim Region. The statewide average for this period was 27.1 per 100,000 children and adolescents. CONCLUSIONS: Firearm injuries are a leading cause of serious and fatal injuries to children and youth in Alaska. This study suggests that many children and adolescents in Alaska who were injured by firearms, or who caused injury to other children or youth by firearms, had easy access to them. Efforts should be made to convince adults not to let children or at risk teenagers have unsupervised access to firearms, and to promote safe storage of firearms.

Accidents↗
PubMedDate not supplied

Traumatic brain injuries in Alaska, 1996-1998.

Traumatic brain injuries often lead to severe disability or death. These injuries most often affect younger, more active people and are likely to have enduring physical, emotional, and financial costs. In order to determine the incidence, etiology and severity of traumatic brain injuries in Alaska, the Alaska Department of Health and Social Services has conducted a three-year study of the demographic and epidemiologic characteristics of traumatic brain injuries in Alaska. From 1996 through 1998, 1,932 hospitalized cases or out-of-hospital deaths occurred in the state among Alaska residents, for an average incidence rate of 105.2 per 100,000 population. To analyze the incidence of these injuries, the Traumatic Brain Injury Surveillance Project analyzed the location, demographics, and etiology.

Accidents↗
PubMed2000

Hypothermia-related deaths--Alaska, October 1998-April 1999, and trends in the United States, 1979-1996.

Hypothermia is defined as an unintentional lowering of the core body temperature to < or = 95 F (< or = 35 C) (1). It is a medical emergency with a high fatality rate (2). In the United States, hypothermia-related deaths can occur anywhere, including in states with milder climates (e.g., Georgia and North Carolina) where weather systems can cause rapid changes in temperature. However, the highest hypothermia-related death rates in the United States occur in northern states, where winter is characterized by moderate to severe cold temperatures (e.g., Alaska and Montana), and western states, where profound declines in nighttime temperatures may occur at high elevations (e.g., New Mexico). From October 1998 through April 1999, 16 deaths attributed to hypothermia (International Classification of Diseases, Ninth Revision [ICD-9], codes E901.0, E901.8, and E901.9; excludes man-made cold [E901.1]) were reported to the Alaska State Medical Examiner. This report describes selected cases of hypothermia-related deaths in Alaska during October 1998-April 1999; compares age-, sex-, and race-specific rates in Alaska and the rest of the United States during 1979-1996; and summarizes trends for hypothermia-related deaths in the United States during 1979-1996.

Adolescent↗
PubMedDate not supplied

Alaska's obstetrical delivery systems: a descriptive epidemiologic study.

Delivery of obstetrical care in rural Alaska can be very challenging, due to remoteness, lack of medical resources and transportation difficulties. This descriptive study looks at what the current delivery systems for obstetrical care in Alaska are. Alaska's obstetrical delivery systems can be divided into three basic systems. 1) Full comprehensive obstetrical care limited only by lack of neonatal ICU capability. 2) Cesarean delivery capable, but with limited resources. 3) Low risk vaginal deliveries with no cesarean delivery capability except by transports approaching 6 hours. This study raises questions about which system is most effective for which communities. Further studies need to be undertaken to better understand how to provide effective obstetrical care in rural and bush Alaska at an acceptable risk, and at reasonable cost.

Alaska↗
PubMedDate not supplied

Racial differences in newborn intensive care morbidity in Alaska.

Birthweight-specific neonatal mortality for Alaska Natives is higher than for non-natives for the years 1987-1996. We investigated the reasons for this based on Level III Neonatal Intensive Care Unit information available from 1991-1996. We also investigated whether differences in mortality extended to measures of morbidity. There were less Native patients born at the tertiary care center for babies with birthweight < 1500 grams and 1500-2499 grams (64% for Natives and 87% for non-natives, p = .000). Differences in antenatal referral were only apparent for the population residing within the Anchorage/Mat-Su area. There were also less cesarean deliveries for Native infants that were born outside of the tertiary care center for both birthweight categories (25% for Native vs. 53% for non-native infants < 1500 grams, p = .01; 27% for Native vs. 48% for non-native infants 1500-2499 grams, p = .01). For Alaska Native babies < 1500 grams there was more necrotizing enterocolitis (13% in Native vs. 4.9% in non-native, p = .01), more severe retinopathy of prematurity (12% in Native vs. 4.6% in non-native, p = .01), and more bronchopulmonary dysplasia (49% in Native vs. 34% in non-native, p = .04). For Alaska Native babies 1500-2499 grams that needed ventilatory assistance there was more intraventricular hemorrhage (19% in Native vs. 7.4% in non-native, p = .003), more severe (grade 3-4) intraventricular hemorrhage (9.5% in Native vs. 0.9% in nonnative, p = .001), and more acquired sepsis (7.1% in Native vs. 1.7% in non-native, p = .02). Differences in access to Level III perinatal care and intrapartum care (cesarean delivery rates) are likely factors that contribute to the worse outcomes in the Alaska Native population.

Alaska↗
PubMed2001

The Alaska Native diabetes program.

OBJECTIVES: To provide optimum health care to indigenous people with diabetes, to prevent diabetes, and to monitor the epidemiology of diabetes and selected complications. The purposes of this paper are to describe the program and to present data that highlights the major problems and successes. STUDY DESIGN: Descriptive epidemiology report of diabetes and population service program based on yearly chart review data. METHODS: Almost half of Alaska Natives with diabetes have no direct access to physicians or hospitals. Health care delivery is now managed by the tribes themselves. Program emphases include maintenance of a population-based registry, formal training for village health aides, physical activity programs, patient education, primary prevention activities and adherence to standards of care to prevent complications. A centralized registry is maintained to assure that epidemiological data is available and patients are not lost to follow-up. Each year a random sample of charts at each major facility is audited against nationally standardized care guidelines. RESULTS: The prevalence of diabetes among Alaska Natives increased 80% over the 13 years from 1985 to 1998 (15.7/1000 to 28.3/1000, age adjusted to U.S. 1980 population). For the years 1986-1998 the incidence rates of lower extremity amputation and end stage renal disease were 6.1/1000 and 2.0/1000 respectively. The level of care provided to Alaska Native patients is comparable to that provided to the general diabetic patient population seen in Alaskan urban clinics. CONCLUSIONS: In spite of logistic challenges, care provided to Alaska Native people with diabetes compares favorably to that provided in other settings. Incidence rates of lower extremity amputation and end stage renal disease also remain comparable to or lower than those in other U.S. populations. Many aspects of our system could be extended to other chronic disease programs serving isolated indigenous populations. Primary prevention of diabetes remains a major challenge as life styles change.

Alaska↗
PubMed2001

Community well being and infectious diseases among Alaska Native communities in the Chugach Region.

OBJECTIVES: This study sought to examine how Native people of the Chugach Region of Alaska perceive their own communities' health and well being, particularly in regard to infectious diseases. STUDY DESIGN: Prospective focus group interview survey. METHODS: During September to December 1999, 12 focus groups were conducted in seven communities in the Chugach Region of Alaska with 97 participants. Using a set of eight questions, information gathered provided insights into the participants' health-related perceptions and provided previously nonexistent baseline data pertaining toTB and hepatitis. RESULTS: Participants showed a good working knowledge of common infectious diseases. There were misconceptions and a potential for increased knowledge in highly prevalent diseases, but more recently delineated infections in rural Alaska, e.g., respiratory syncvtial virus (RSV), Helicobacter pylori, and less prevalent diseases, e.g., Acquired Immunodeficiency Syndrome (AIDS). The participants expressed a desire for further infectious disease information and dialogue. CONCLUSIONS: This process can be used to develop a risk assessment tool for medical and clinical providers' use in an effort to increase testing for such infectious diseases as HIV, TB, Hepatitis C, and sexually transmitted diseases (STDs). In this case the authors also produced a STD prevention video for rural Alaska Natives, entitled, Summer Sun Winter Moon.

Adolescent↗